2027 ICD-10-CM Diagnosis Code C61Malignant neoplasm of prostate
ICD-10-CM Codes›C00–D49›C60-C63›C61
- Billable — Valid for Submission
- Risk Adjusts — HCC 23
- Chronic Condition
C61 is a billable ICD-10-CM diagnosis code for malignant neoplasm of prostate. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 715 through 716, 722 through 724. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Male reproductive system cancers - prostate.
For Medicare Advantage risk adjustment, C61 maps to CMS-HCC Category 23 (Prostate, Breast, and Other Cancers and Tumors) under the V28 model, adding a risk factor of about 0.186 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Quality Payment Program MeasuresBilling
Medicare quality measures that can apply when C61 is part of the patient record.
Radical Prostatectomy Pathology Reporting
High Priority: NO
Measure Type: Process
Submission Methods: Claims, Registry
Description: Percentage of radical prostatectomy pathology reports that include the pT category, the pN category, the Gleason score and a statement about margin status.
Medicare Risk Adjustment (HCC)Billing
C61 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.
- Acinar cell cystadenocarcinoma of prostate
- Adenocarcinoma of prostate
- Carcinoma of prostate
- Endometrioid carcinoma of prostate
- Extraprostatic extension of tumor present
- Extraprostatic extension of tumor present, focal
- Extraprostatic extension of tumor present, multifocal
- Extraprostatic extension of tumor present, non-focal
- Extraprostatic extension of tumor present, unifocal
- Familial prostate cancer
- Hormone refractory prostate cancer
- Hormone sensitive prostate cancer
- Infiltrating duct carcinoma of prostate
- Local recurrence of malignant neoplasm of prostate
- Malignant neoplasm involving urinary bladder by direct extension from prostate
- Malignant neoplasm of prostate
- Malignant neoplasm of seminal vesicle
- Malignant tumor involving an organ by direct extension from prostate
- Malignant tumor involving rectum by direct extension from prostate
- Malignant tumor involving seminal vesicle by direct extension from prostate
- Malignant tumor involving urethra by direct extension from prostate
- Malignant tumor involving vasa deferentia by direct extension from prostate
- Neoplasm of seminal vesicle
- Non-metastatic prostate cancer
- Obstructive nephropathy due to malignancy
- Obstructive nephropathy due to prostate cancer
- Primary acinar cell cystadenocarcinoma of prostate
- Primary adenocarcinoma of prostate
- Primary carcinoma of prostate
- Primary endometrioid carcinoma of prostate
- Primary infiltrating duct carcinoma of prostate
- Primary malignant hormone-refractory neoplasm of prostate
- Primary malignant neoplasm of prostate
- Prostate cancer metastatic to eye
- Recurrent malignant neoplasm of prostate
- Squamous cell carcinoma of male genital
- Squamous cell carcinoma of prostate
- Tumor invasion of perineural tissue absent
- Tumor invasion of perineural tissue present
- Tumor invasion of periprostatic fat absent
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to C61: its own notes plus those printed at block C60-C63 and Chapter 2. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- malignant neoplasm of skin of male genital organs
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- malignant neoplasm of seminal vesicle (C63.7)
Use Additional Code
Add a second code, after this one, to fully describe the condition.
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 C61, its category, or a range that includes it.
Applicable To 2
These notes mention C61.
Excludes2 1
These codes carry an Excludes2 note naming C61: its condition is not part of those codes, and both may be reported when the patient has both.
- N40 Benign prostatic hyperplasiamalignant neoplasm of prostate (C61)
Code First 1
These codes say to code first a condition named in the note, and C61 is one of the conditions named.
- Z79.81 Long term (current) use of agents affecting estrogen receptors and estrogen levelsmalignant neoplasm of prostate (C61)
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Adenocarcinoma See Also: Neoplasm, malignant, by site;
male C61
Carcinoma (malignant) See Also: Neoplasm, by site, malignant;
Cystadenocarcinoma See: Neoplasm, malignant, by site;
endometrioid See: Neoplasm, malignant, by site;
male C61
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Malignant Prostate Neoplasm
a primary or metastatic malignant tumor involving the prostate gland. the vast majority are carcinomas.
Table of NeoplasmsClinical
Patient EducationClinical
Prostate Cancer
Cancer is a disease in which cells in the body grow out of control. Prostate cancer begins in the cells of the prostate. The prostate is a gland in the male reproductive system. It lies just below the bladder. It makes fluid that is part of semen.
The full article covers:
- What is prostate cancer?
- What causes prostate cancer?
- Who is more likely to develop prostate cancer?
- What are the symptoms of prostate cancer?
- What are prostate tests and how is prostate cancer diagnosed?
- What are the treatments for prostate cancer?
- Can prostate cancer be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert C61 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About C61Overview
What is the ICD-10 code for malignant neoplasm of prostate?
The ICD-10-CM code for malignant neoplasm of prostate is C61. It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is C61 (Malignant neoplasm of prostate) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report malignant neoplasm of prostate on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does C61 group to?
When malignant neoplasm of prostate is the principal diagnosis on an inpatient stay, it groups to MS-DRG 716, 723, 724, 715, 722, with relative weights from 0.5709 to 2.2896 depending on complications. Higher weights mean higher Medicare reimbursement.
Can C61 be reported with C63.7?
Not as a rule. The Excludes1 note on C61 lists "malignant neoplasm of seminal vesicle (C63.7)". 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).
Does C61 need an additional code?
When the condition applies, yes. The Use Additional Code note reads: code, if applicable, to identify: hormone sensitivity status (Z19.1-Z19.2); rising PSA following treatment for malignant neoplasm of prostate (R97.21). The additional code is reported after C61.
What HCC is C61?
C61 (malignant neoplasm of prostate) maps to CMS-HCC Category 23 (Prostate, Breast, and Other Cancers and Tumors), commonly written as HCC 23, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 12 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 22.
Does C61 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, C61 adds a risk adjustment factor of about 0.186 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.186 to 0.237 depending on the payment segment). A more severe related category (HCC 17, HCC 18, HCC 19, HCC 20, HCC 21, and HCC 22) supersedes it when both are reported. See the full factor table on the HCC 23 category page.
