What is ICD-10 code D44.5?

D44.5 is the ICD-10-CM diagnosis code for Neoplasm of uncertain behavior of pineal gland. A tumor of the pineal gland (a small gland in the brain) that cannot yet be classified as definitely benign or malignant. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). D44.5 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D44.5 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. D44.5 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. D44.5 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does D44.5 map to under V28?

D44.5 maps to CMS-HCC V28 23 (Prostate, Breast, and Other Cancers and Tumors). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does D44.5 pay in RAF?

D44.5 carries a community, non-dual, aged (CNA) RAF weight of 0.186 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for D44.5?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For D44.5, V28 maps to Prostate, Breast, and Other Cancers and Tumors at RAF 0.186 while V24 mapped to Breast, Prostate, and Other Cancers and Tumors at RAF 0.150. Both models can still appear in legacy data and in payer-specific lookback periods.

2026 ICD-10-CM D44.5: Neoplasm of uncertain

D44.5 maps to CMS-HCC V28 23 (RAF 0.186). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

ICD-10-CM Code View

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Code lookupD44.5Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48)

D44.5

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Neoplasm of uncertain behavior of pineal gland

A tumor of the pineal gland (a small gland in the brain) that cannot yet be classified as definitely benign or malignant.

Buddy Insight

Neoplasms of uncertain behavior of the pineal gland include tumors such as pineocytomas with atypical features or pineal parenchymal tumors of intermediate differentiation.

CMS-HCC V28

Mapped

HCC 23

Prostate, Breast, and Other C...

RAF 0.186

CMS-HCC V24

Mapped

HCC 12

Breast, Prostate, and Other C...

RAF 0.150

ACA/HHS

Mapped

HCC 12

HHS-HCC 12

Varies by metal level

ESRD/PACE

Mapped

HCC 12

Breast, Prostate, and Other C...

RAF 0.045

RXHCC

Mapped

HCC 22

Cancer, Other Specified Sites

RAF 0.124

Code Book Path

Official

D44Neoplasm of uncertain behavior of endocrine glands

D44.5Neoplasm of uncertain behavior of pineal gland

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for D44.5 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D44.5 in this effective period.

Related Child Codes

Official

D44.0Neoplasm of uncertain behavior of thyroid gland

D44.1Neoplasm of uncertain behavior of adrenal gland

D44.2Neoplasm of uncertain behavior of parathyroid gland

D44.3Neoplasm of uncertain behavior of pituitary gland

D44.4Neoplasm of uncertain behavior of craniopharyngeal duct

Includes

Official

ICD-10-CM does not list Includes notes for D44.5 in this effective period.

Excludes 1

Official

multiple endocrine adenomatosis (E31.2-)
multiple endocrine neoplasia (E31.2-)
neoplasm of uncertain behavior of endocrine pancreas (D37.8)
neoplasm of uncertain behavior of ovary (D39.1-)
neoplasm of uncertain behavior of testis (D40.1-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D44.5 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D44.5 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D44.5 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation must specify the pineal gland location, supported by brain magnetic resonance imaging showing a pineal region mass.

Pathology should describe histological features supporting uncertain behavior.

Document any signs of obstructive hydrocephalus, visual symptoms, or endocrine disturbances (precocious puberty in children).

MEAT Support

HCC Buddy guidance

Documentation must specify the pineal gland location, supported by brain magnetic resonance imaging showing a pineal region mass.

Pathology should describe histological features supporting uncertain behavior.

Document any signs of obstructive hydrocephalus, visual symptoms, or endocrine disturbances (precocious puberty in children).

Audit Caution

HCC Buddy guidance

Pineal region tumors include germ cell tumors, which are coded differently from pineal parenchymal tumors.

Ensure pathology specifically identifies a pineal parenchymal or pineal gland origin rather than a germ cell tumor arising in the pineal region.

Do not use this code for pineal cysts, which are typically benign and non-neoplastic.

Common Mistakes

HCC Buddy guidance

D35.4 (benign neoplasm of pineal gland) is used for confirmed benign pineal tumors such as typical pineocytomas.

C75.3 (malignant neoplasm of pineal gland) is used for pineoblastomas and malignant pineal tumors.

D43.1 (uncertain behavior of infratentorial brain) may be confused if the pineal tumor is not correctly localized.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is D44.5 an HCC code?

Yes. D44.5 (Neoplasm of uncertain behavior of pineal gland) maps to Prostate, Breast, and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors under V24), with a community non-dual aged RAF of 0.186. It is billable for payment year 2026.

Coder answer: D44.5 is billable and maps to V28 HCC 23, Prostate, Breast, and Other Cancers and Tumors. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: D44.5
Description: Neoplasm of uncertain behavior of pineal gland
HCC (V28): HCC 23 — Prostate, Breast, and Other Cancers and Tumors
RAF: 0.186
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 23, Prostate, Breast, and Other Cancers and Tumors

0.186

V24HCC 12, Breast, Prostate, and Other Cancers and Tumors

0.150

ESRDHCC 12, Breast, Prostate, and Other Cancers and Tumors

0.045

RxHCCHCC 22, Cancer, Other Specified Sites

0.124

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work D44.5 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for D44.5

For D44.5 to 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 D44.5 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

D44.5 is the ICD-10-CM diagnosis code for neoplasm of uncertain behavior of pineal gland. A tumor of the pineal gland (a small gland in the brain) that cannot yet be classified as definitely benign or malignant. D44.5 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, D44.5 maps to Prostate, Breast, and Other Cancers and Tumors (HCC 23) with a community, non-dual, aged base RAF weight of 0.186. Under the older CMS-HCC V24 model, D44.5 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.

Document any hormonal symptoms or melatonin-related findings if present. Because D44.5 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 D44.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document any hormonal symptoms or melatonin-related findings if present
•Ensure pathology report confirms uncertain behavior classification before coding

Clinical Significance

Neoplasms of uncertain behavior of the pineal gland include tumors such as pineocytomas with atypical features or pineal parenchymal tumors of intermediate differentiation. These tumors can cause obstructive hydrocephalus by compressing the cerebral aqueduct and may present with Parinaud syndrome (upgaze paralysis) due to tectal compression.

Documentation Requirements

✓Documentation must specify the pineal gland location, supported by brain magnetic resonance imaging showing a pineal region mass.
✓Pathology should describe histological features supporting uncertain behavior.
✓Document any signs of obstructive hydrocephalus, visual symptoms, or endocrine disturbances (precocious puberty in children).

Commonly Confused Codes

•D35.4 (benign neoplasm of pineal gland) is used for confirmed benign pineal tumors such as typical pineocytomas.
•C75.3 (malignant neoplasm of pineal gland) is used for pineoblastomas and malignant pineal tumors.
•D43.1 (uncertain behavior of infratentorial brain) may be confused if the pineal tumor is not correctly localized.