D43.2 ICD-10-CM Code: Neoplasm of uncertain behavior of brain, unspecified
HCC Buddy Code Card
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FY 2026 Apr update / Neoplasms (C00-D49) / Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48)
D43.2
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNeoplasm of uncertain behavior of brain, unspecified
A growth in the brain that cannot yet be classified as definitely cancer or definitely benign, but the exact location within the brain is not specified.
Buddy Insight
This unspecified code represents a brain neoplasm of uncertain behavior when the supratentorial or infratentorial location cannot be determined.
CMS-HCC V28
MappedHCC 23
RAF 0.251
CMS-HCC V24
MappedHCC 12
RAF 0.150
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 12
RAF 0.0
RXHCC
MappedHCC 22
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for D43.2 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for D43.2 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for D43.2 in this effective period.
Excludes 1
Official- neoplasm of uncertain behavior of peripheral nerves and autonomic nervous system (D48.2)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D43.2 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D43.2 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D43.2 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is D43.2 an HCC code?
Yes. D43.2 maps to Melanoma and Other Skin Cancers under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for D43.2
For D43.2to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed D43.2 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
D43.2 is the ICD-10-CM diagnosis code for neoplasm of uncertain behavior of brain, unspecified. A growth in the brain that cannot yet be classified as definitely cancer or definitely benign, but the exact location within the brain is not specified. D43.2 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).
Under the CMS-HCC V28 risk adjustment model, D43.2 maps to Melanoma and Other Skin Cancers (HCC 23) with a community, non-dual, aged base RAF weight of 0.251. Under the older CMS-HCC V24 model, D43.2 maps to Breast, Prostate, and Other Cancers and Tumors (HCC 12) with a community, non-dual, aged base RAF weight of 0.150. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Use this code only when the specific brain location (supratentorial vs. infratentorial) cannot be determined from documentation. Because D43.2 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D43.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
This unspecified code represents a brain neoplasm of uncertain behavior when the supratentorial or infratentorial location cannot be determined. Using this code limits prognostic value because tumor location within the brain significantly influences treatment options, surgical approach, and expected outcomes.
Documentation Requirements
- ✓Use this code only when documentation does not specify whether the tumor is supratentorial or infratentorial.
- ✓Query the provider and review neuroimaging to identify the specific brain region.
- ✓Pathology confirmation of uncertain behavior is still required regardless of anatomical specification.