Z85.3 ICD-10-CM Code: Personal history of malignant neoplasm of breast
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)
Z85.3
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePersonal history of malignant neoplasm of breast
A patient who previously had breast cancer but is no longer being treated for it.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
Official- Conditions classifiable to C50.-
Excludes 2
Official- personal history of benign neoplasm (Z86.01-)
- personal history of carcinoma-in-situ (Z86.00-)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Z85.3 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for Z85.3 in this effective period.
Code First
Official- any follow-up examination after treatment of malignant neoplasm (Z08)
Use Additional
Official- code to identify:
- alcohol use and dependence (F10.-)
- exposure to environmental tobacco smoke (Z77.22)
- history of tobacco dependence (Z87.891)
- occupational exposure to environmental tobacco smoke (Z57.31)
Code Also
OfficialICD-10-CM does not list Code Also instructions for Z85.3 in this effective period.
Buddy Documentation Tip
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 Z85.3 an HCC code?
No. Z85.3 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
Z85.3 is the ICD-10-CM diagnosis code for personal history of malignant neoplasm of breast. A patient who previously had breast cancer but is no longer being treated for it. Z85.3 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons with potential health hazards related to family and personal history and certain conditions influencing health status (z77-z99).
Z85.3 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.
This code applies to both male and female patients with a history of breast cancer.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z85.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code applies to both male and female patients with a history of breast cancer.
- •Use this code regardless of which breast was affected or whether it was unilateral or bilateral.