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D43

Non-Billable (Header)

Neoplasm of uncertain behavior of brain and central nervous system

Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)

What This Code Means

D43 is the ICD-10-CM diagnosis code for neoplasm of uncertain behavior of brain and central nervous system. D43 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (d37-d48).

Header codes like D43 cannot be reported on claims directly — they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at D43's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D43 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Excludes 1 — Do NOT code together

  • neoplasm of uncertain behavior of peripheral nerves and autonomic nervous system (D48.2)

Child Codes

Code Hierarchy

D43Neoplasm of uncertain behavior of brain and central nervous system
D43Neoplasm of uncertain behavior of brain and central nervous system

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