2027 ICD-10-CM Diagnosis Code C25.1Malignant neoplasm of body of pancreas
ICD-10-CM Codes›C00–D49›C15-C26›C25
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 20
- Chronic Condition
C25.1 is a billable ICD-10-CM diagnosis code for malignant neoplasm of body of pancreas. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 435 through 437. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 26 closely related codes. Coders also document this condition as carcinoma of body of pancreas. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Endocrine system cancers - pancreas.
For Medicare Advantage risk adjustment, C25.1 maps to CMS-HCC Category 20 (Lung and Other Severe Cancers) under the V28 model, adding a risk factor of about 1.136 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
C25.1 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Carcinoma of body of pancreas
- Malignant neoplasm of body of pancreas
- Neoplasm of body of pancreas
- Primary adenocarcinoma of body of pancreas
- Primary adenocarcinoma of pancreas
- Primary carcinoma of body of pancreas
- Primary carcinoma of pancreas
- Primary malignant neoplasm of body of pancreas
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to C25.1: its own notes plus those printed at C25, block C15-C26, and Chapter 2. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- Kaposi's sarcoma of gastrointestinal sites (C46.4)
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- gastrointestinal stromal tumors (C49.A-)
Use Additional Code
Add a second code, after this one, to fully describe the condition.
Code Also
A second code may be needed to fully describe the condition; the note gives no sequencing direction.
Notes
General instructions on how these codes are used.
- Functional activity
- All neoplasms are classified in this chapter, whether they are functionally active or not. An additional code from Chapter 4 may be used, to identify functional activity associated with any neoplasm.
- Morphology [Histology]
- Chapter 2 classifies neoplasms primarily by site (topography), with broad groupings for behavior, malignant, in situ, benign, etc. The Table of Neoplasms should be used to identify the correct topography code. In a few cases, such as for malignant melanoma and certain neuroendocrine tumors, the morphology (histologic type) is included in the category and codes.
- Primary malignant neoplasms overlapping site boundaries
- A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere. For multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of the same breast, codes for each site should be assigned.
- Malignant neoplasm of ectopic tissue
- Malignant neoplasms of ectopic tissue are to be coded to the site mentioned, e.g., ectopic pancreatic malignant neoplasms are coded to pancreas, unspecified (C25.9).
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name C25.1, its category, or a range that includes it.
Applicable To 2
These notes mention C25.1.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Malignant Pancreatic Neoplasm
a primary or metastatic malignant neoplasm that affects the pancreas.
Table of NeoplasmsClinical
Patient EducationClinical
Pancreatic Cancer
The pancreas is a gland behind your stomach and in front of your spine. It produces the juices that help break down food and the hormones that help control blood sugar levels. Pancreatic cancer usually begins in the cells that produce the juices. Some risk factors for developing pancreatic cancer include:
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert C25.1 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About C25.1Overview
What is the ICD-10 code for malignant neoplasm of body of pancreas?
The ICD-10-CM code for malignant neoplasm of body of pancreas is C25.1 (sometimes written as C251). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is C25.1 (Malignant neoplasm of pancreas) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report malignant neoplasm of body of pancreas on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does C25.1 group to?
When malignant neoplasm of body of pancreas is the principal diagnosis on an inpatient stay, it groups to MS-DRG 436, 437, 435, with relative weights from 0.8078 to 1.8428 depending on complications. Higher weights mean higher Medicare reimbursement.
Is C25.1 a CC or MCC?
CMS lists C25.1 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 26 closely related codes in its exclusion list.
Can C25.1 be reported with C46.4?
Not as a rule. The Excludes1 note at block C15-C26, which applies to C25.1, lists "Kaposi's sarcoma of gastrointestinal sites (C46.4)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is C25.1?
C25.1 (malignant neoplasm of body of pancreas) maps to CMS-HCC Category 20 (Lung and Other Severe Cancers), commonly written as HCC 20, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 9 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 20.
Does C25.1 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, C25.1 adds a risk adjustment factor of about 1.136 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.672 to 1.214 depending on the payment segment). A more severe related category (HCC 17, HCC 18, and HCC 19) supersedes it when both are reported. See the full factor table on the HCC 20 category page.
