D49.4
BillableNeoplasm of unspecified behavior of bladder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D49.4 an HCC code?
No. D49.4 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
D49.4 is the ICD-10-CM diagnosis code for neoplasm of unspecified behavior of bladder. A tumor or growth of unknown behavior found in the bladder. D49.4 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering neoplasms of unspecified behavior (d49).
D49.4 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Review cystoscopy or biopsy reports to clarify whether the lesion is benign (D30.3) or malignant (C67).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D49.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.