CMS-HCC Risk Adjustment · V28 Model · Payment Year 2026 234 Codes

HCC 23: Prostate, Breast, and Other Cancers and Tumors ICD-10-CM

CMS-HCC Category 23 (Prostate, Breast, and Other Cancers and Tumors) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.186 and 0.237 to a beneficiary's RAF score depending on the payment segment (0.186 for a community, non-dual, aged enrollee). 234 ICD-10-CM diagnosis codes map to HCC 23. A more severe related category (HCC 17, HCC 18, HCC 19, HCC 20, HCC 21, and HCC 22) supersedes it when both are reported.

✓ Built from the official CMS PY 2026 risk adjustment filesV28 pays 100% of MA risk scores from PY 2026

+0.186

RAF, Community Non-Dual Aged

234

ICD-10-CM Codes

HCC 17

Superseded By

PY 2026

Dataset

CMS-HCC V28

RAF Weight by Payment Segment 7 segments

Payment Segment	Relative Factor
Community, non-dual, aged	0.186
Community, partial-benefit dual, aged	0.203
Community, full-benefit dual, aged	0.196
Community, non-dual, disabled	0.233
Community, partial-benefit dual, disabled	0.237
Community, full-benefit dual, disabled	0.218
Institutional	0.197

A beneficiary is scored in exactly one segment, set by Medicaid (dual) status, aged or disabled entitlement, and residence. Factors are relative weights, not dollar amounts; new-enrollee segments score on demographics only. In the hierarchy, HCC 17 (Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic), HCC 18 (Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid), HCC 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers), HCC 20 (Lung and Other Severe Cancers), HCC 21 (Lymphoma and Other Cancers), and HCC 22 (Bladder, Colorectal, and Other Cancers) supersede HCC 23 when reported together.

ICD-10-CM

ICD-10-CM Codes That Map to HCC 23 234 codes

234 of 234 shown

C43.0 Malignant melanoma of lip from V24 HCC 12
C43.10 Malignant melanoma of unspecified eyelid, including canthus from V24 HCC 12
C43.111 Malignant melanoma of right upper eyelid, including canthus from V24 HCC 12
C43.112 Malignant melanoma of right lower eyelid, including canthus from V24 HCC 12
C43.121 Malignant melanoma of left upper eyelid, including canthus from V24 HCC 12
C43.122 Malignant melanoma of left lower eyelid, including canthus from V24 HCC 12
C43.20 Malignant melanoma of unspecified ear and external auricular canal from V24 HCC 12
C43.21 Malignant melanoma of right ear and external auricular canal from V24 HCC 12
C43.22 Malignant melanoma of left ear and external auricular canal from V24 HCC 12
C43.30 Malignant melanoma of unspecified part of face from V24 HCC 12
C43.31 Malignant melanoma of nose from V24 HCC 12
C43.39 Malignant melanoma of other parts of face from V24 HCC 12
C43.4 Malignant melanoma of scalp and neck from V24 HCC 12
C43.51 Malignant melanoma of anal skin from V24 HCC 12
C43.52 Malignant melanoma of skin of breast from V24 HCC 12
C43.59 Malignant melanoma of other part of trunk from V24 HCC 12
C43.60 Malignant melanoma of unspecified upper limb, including shoulder from V24 HCC 12
C43.61 Malignant melanoma of right upper limb, including shoulder from V24 HCC 12
C43.62 Malignant melanoma of left upper limb, including shoulder from V24 HCC 12
C43.70 Malignant melanoma of unspecified lower limb, including hip from V24 HCC 12
C43.71 Malignant melanoma of right lower limb, including hip from V24 HCC 12
C43.72 Malignant melanoma of left lower limb, including hip from V24 HCC 12
C43.8 Malignant melanoma of overlapping sites of skin from V24 HCC 12
C43.9 Malignant melanoma of skin, unspecified from V24 HCC 12
C47.4 Malignant neoplasm of peripheral nerves of abdomen from V24 HCC 10
C49.4 Malignant neoplasm of connective and soft tissue of abdomen from V24 HCC 10
C49.A0 Gastrointestinal stromal tumor, unspecified site from V24 HCC 10
C49.A1 Gastrointestinal stromal tumor of esophagus from V24 HCC 10
C49.A2 Gastrointestinal stromal tumor of stomach from V24 HCC 10
C49.A3 Gastrointestinal stromal tumor of small intestine from V24 HCC 10
C49.A4 Gastrointestinal stromal tumor of large intestine from V24 HCC 10
C49.A5 Gastrointestinal stromal tumor of rectum from V24 HCC 10
C49.A9 Gastrointestinal stromal tumor of other sites from V24 HCC 10
C50.011 Malignant neoplasm of nipple and areola, right female breast from V24 HCC 12
C50.012 Malignant neoplasm of nipple and areola, left female breast from V24 HCC 12
C50.019 Malignant neoplasm of nipple and areola, unspecified female breast from V24 HCC 12
C50.021 Malignant neoplasm of nipple and areola, right male breast from V24 HCC 12
C50.022 Malignant neoplasm of nipple and areola, left male breast from V24 HCC 12
C50.029 Malignant neoplasm of nipple and areola, unspecified male breast from V24 HCC 12
C50.111 Malignant neoplasm of central portion of right female breast from V24 HCC 12
C50.112 Malignant neoplasm of central portion of left female breast from V24 HCC 12
C50.119 Malignant neoplasm of central portion of unspecified female breast from V24 HCC 12
C50.121 Malignant neoplasm of central portion of right male breast from V24 HCC 12
C50.122 Malignant neoplasm of central portion of left male breast from V24 HCC 12
C50.129 Malignant neoplasm of central portion of unspecified male breast from V24 HCC 12
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast from V24 HCC 12
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast from V24 HCC 12
C50.219 Malignant neoplasm of upper-inner quadrant of unspecified female breast from V24 HCC 12
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast from V24 HCC 12
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast from V24 HCC 12
C50.229 Malignant neoplasm of upper-inner quadrant of unspecified male breast from V24 HCC 12
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast from V24 HCC 12
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast from V24 HCC 12
C50.319 Malignant neoplasm of lower-inner quadrant of unspecified female breast from V24 HCC 12
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast from V24 HCC 12
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast from V24 HCC 12
C50.329 Malignant neoplasm of lower-inner quadrant of unspecified male breast from V24 HCC 12
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast from V24 HCC 12
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast from V24 HCC 12
C50.419 Malignant neoplasm of upper-outer quadrant of unspecified female breast from V24 HCC 12
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast from V24 HCC 12
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast from V24 HCC 12
C50.429 Malignant neoplasm of upper-outer quadrant of unspecified male breast from V24 HCC 12
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast from V24 HCC 12
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast from V24 HCC 12
C50.519 Malignant neoplasm of lower-outer quadrant of unspecified female breast from V24 HCC 12
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast from V24 HCC 12
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast from V24 HCC 12
C50.529 Malignant neoplasm of lower-outer quadrant of unspecified male breast from V24 HCC 12
C50.611 Malignant neoplasm of axillary tail of right female breast from V24 HCC 12
C50.612 Malignant neoplasm of axillary tail of left female breast from V24 HCC 12
C50.619 Malignant neoplasm of axillary tail of unspecified female breast from V24 HCC 12
C50.621 Malignant neoplasm of axillary tail of right male breast from V24 HCC 12
C50.622 Malignant neoplasm of axillary tail of left male breast from V24 HCC 12
C50.629 Malignant neoplasm of axillary tail of unspecified male breast from V24 HCC 12
C50.811 Malignant neoplasm of overlapping sites of right female breast from V24 HCC 12
C50.812 Malignant neoplasm of overlapping sites of left female breast from V24 HCC 12
C50.819 Malignant neoplasm of overlapping sites of unspecified female breast from V24 HCC 12
C50.821 Malignant neoplasm of overlapping sites of right male breast from V24 HCC 12
C50.822 Malignant neoplasm of overlapping sites of left male breast from V24 HCC 12
C50.829 Malignant neoplasm of overlapping sites of unspecified male breast from V24 HCC 12
C50.911 Malignant neoplasm of unspecified site of right female breast from V24 HCC 12
C50.912 Malignant neoplasm of unspecified site of left female breast from V24 HCC 12
C50.919 Malignant neoplasm of unspecified site of unspecified female breast from V24 HCC 12
C50.921 Malignant neoplasm of unspecified site of right male breast from V24 HCC 12
C50.922 Malignant neoplasm of unspecified site of left male breast from V24 HCC 12
C50.929 Malignant neoplasm of unspecified site of unspecified male breast from V24 HCC 12
C50.A0 Malignant inflammatory neoplasm of unspecified breast new to V28
C50.A1 Malignant inflammatory neoplasm of right breast new to V28
C50.A2 Malignant inflammatory neoplasm of left breast new to V28
C54.0 Malignant neoplasm of isthmus uteri from V24 HCC 12
C54.1 Malignant neoplasm of endometrium from V24 HCC 12
C54.2 Malignant neoplasm of myometrium from V24 HCC 12
C54.3 Malignant neoplasm of fundus uteri from V24 HCC 12
C54.8 Malignant neoplasm of overlapping sites of corpus uteri from V24 HCC 12
C54.9 Malignant neoplasm of corpus uteri, unspecified from V24 HCC 12
C55 Malignant neoplasm of uterus, part unspecified from V24 HCC 12
C60.0 Malignant neoplasm of prepuce from V24 HCC 12
C60.1 Malignant neoplasm of glans penis from V24 HCC 12
C60.2 Malignant neoplasm of body of penis from V24 HCC 12
C60.8 Malignant neoplasm of overlapping sites of penis from V24 HCC 12
C60.9 Malignant neoplasm of penis, unspecified from V24 HCC 12
C61 Malignant neoplasm of prostate from V24 HCC 12
C62.00 Malignant neoplasm of unspecified undescended testis from V24 HCC 12
C62.01 Malignant neoplasm of undescended right testis from V24 HCC 12
C62.02 Malignant neoplasm of undescended left testis from V24 HCC 12
C62.10 Malignant neoplasm of unspecified descended testis from V24 HCC 12
C62.11 Malignant neoplasm of descended right testis from V24 HCC 12
C62.12 Malignant neoplasm of descended left testis from V24 HCC 12
C62.90 Malignant neoplasm of unspecified testis, unspecified whether descended or undescended from V24 HCC 12
C62.91 Malignant neoplasm of right testis, unspecified whether descended or undescended from V24 HCC 12
C62.92 Malignant neoplasm of left testis, unspecified whether descended or undescended from V24 HCC 12
C63.00 Malignant neoplasm of unspecified epididymis from V24 HCC 12
C63.01 Malignant neoplasm of right epididymis from V24 HCC 12
C63.02 Malignant neoplasm of left epididymis from V24 HCC 12
C63.10 Malignant neoplasm of unspecified spermatic cord from V24 HCC 12
C63.11 Malignant neoplasm of right spermatic cord from V24 HCC 12
C63.12 Malignant neoplasm of left spermatic cord from V24 HCC 12
C63.2 Malignant neoplasm of scrotum from V24 HCC 12
C63.7 Malignant neoplasm of other specified male genital organs from V24 HCC 12
C63.8 Malignant neoplasm of overlapping sites of male genital organs from V24 HCC 12
C63.9 Malignant neoplasm of male genital organ, unspecified from V24 HCC 12
C69.00 Malignant neoplasm of unspecified conjunctiva from V24 HCC 12
C69.01 Malignant neoplasm of right conjunctiva from V24 HCC 12
C69.02 Malignant neoplasm of left conjunctiva from V24 HCC 12
C69.10 Malignant neoplasm of unspecified cornea from V24 HCC 12
C69.11 Malignant neoplasm of right cornea from V24 HCC 12
C69.12 Malignant neoplasm of left cornea from V24 HCC 12
C69.20 Malignant neoplasm of unspecified retina from V24 HCC 12
C69.21 Malignant neoplasm of right retina from V24 HCC 12
C69.22 Malignant neoplasm of left retina from V24 HCC 12
C69.30 Malignant neoplasm of unspecified choroid from V24 HCC 12
C69.31 Malignant neoplasm of right choroid from V24 HCC 12
C69.32 Malignant neoplasm of left choroid from V24 HCC 12
C69.40 Malignant neoplasm of unspecified ciliary body from V24 HCC 12
C69.41 Malignant neoplasm of right ciliary body from V24 HCC 12
C69.42 Malignant neoplasm of left ciliary body from V24 HCC 12
C69.50 Malignant neoplasm of unspecified lacrimal gland and duct from V24 HCC 12
C69.51 Malignant neoplasm of right lacrimal gland and duct from V24 HCC 12
C69.52 Malignant neoplasm of left lacrimal gland and duct from V24 HCC 12
C69.60 Malignant neoplasm of unspecified orbit from V24 HCC 12
C69.61 Malignant neoplasm of right orbit from V24 HCC 12
C69.62 Malignant neoplasm of left orbit from V24 HCC 12
C69.80 Malignant neoplasm of overlapping sites of unspecified eye and adnexa from V24 HCC 12
C69.81 Malignant neoplasm of overlapping sites of right eye and adnexa from V24 HCC 12
C69.82 Malignant neoplasm of overlapping sites of left eye and adnexa from V24 HCC 12
C69.90 Malignant neoplasm of unspecified site of unspecified eye from V24 HCC 12
C69.91 Malignant neoplasm of unspecified site of right eye from V24 HCC 12
C69.92 Malignant neoplasm of unspecified site of left eye from V24 HCC 12
C73 Malignant neoplasm of thyroid gland from V24 HCC 12
C75.0 Malignant neoplasm of parathyroid gland from V24 HCC 12
C75.4 Malignant neoplasm of carotid body from V24 HCC 12
C75.5 Malignant neoplasm of aortic body and other paraganglia from V24 HCC 12
C75.8 Malignant neoplasm with pluriglandular involvement, unspecified from V24 HCC 12
C75.9 Malignant neoplasm of endocrine gland, unspecified from V24 HCC 12
C76.0 Malignant neoplasm of head, face and neck from V24 HCC 12
C76.1 Malignant neoplasm of thorax from V24 HCC 12
C76.2 Malignant neoplasm of abdomen from V24 HCC 12
C76.3 Malignant neoplasm of pelvis from V24 HCC 12
C76.40 Malignant neoplasm of unspecified upper limb from V24 HCC 12
C76.41 Malignant neoplasm of right upper limb from V24 HCC 12
C76.42 Malignant neoplasm of left upper limb from V24 HCC 12
C76.50 Malignant neoplasm of unspecified lower limb from V24 HCC 12
C76.51 Malignant neoplasm of right lower limb from V24 HCC 12
C76.52 Malignant neoplasm of left lower limb from V24 HCC 12
C76.8 Malignant neoplasm of other specified ill-defined sites from V24 HCC 12
C80.1 Malignant (primary) neoplasm, unspecified from V24 HCC 12
C80.2 Malignant neoplasm associated with transplanted organ from V24 HCC 12
D03.0 Melanoma in situ of lip from V24 HCC 12
D03.10 Melanoma in situ of unspecified eyelid, including canthus from V24 HCC 12
D03.111 Melanoma in situ of right upper eyelid, including canthus from V24 HCC 12
D03.112 Melanoma in situ of right lower eyelid, including canthus from V24 HCC 12
D03.121 Melanoma in situ of left upper eyelid, including canthus from V24 HCC 12
D03.122 Melanoma in situ of left lower eyelid, including canthus from V24 HCC 12
D03.20 Melanoma in situ of unspecified ear and external auricular canal from V24 HCC 12
D03.21 Melanoma in situ of right ear and external auricular canal from V24 HCC 12
D03.22 Melanoma in situ of left ear and external auricular canal from V24 HCC 12
D03.30 Melanoma in situ of unspecified part of face from V24 HCC 12
D03.39 Melanoma in situ of other parts of face from V24 HCC 12
D03.4 Melanoma in situ of scalp and neck from V24 HCC 12
D03.51 Melanoma in situ of anal skin from V24 HCC 12
D03.52 Melanoma in situ of breast (skin) (soft tissue) from V24 HCC 12
D03.59 Melanoma in situ of other part of trunk from V24 HCC 12
D03.60 Melanoma in situ of unspecified upper limb, including shoulder from V24 HCC 12
D03.61 Melanoma in situ of right upper limb, including shoulder from V24 HCC 12
D03.62 Melanoma in situ of left upper limb, including shoulder from V24 HCC 12
D03.70 Melanoma in situ of unspecified lower limb, including hip from V24 HCC 12
D03.71 Melanoma in situ of right lower limb, including hip from V24 HCC 12
D03.72 Melanoma in situ of left lower limb, including hip from V24 HCC 12
D03.8 Melanoma in situ of other sites from V24 HCC 12
D03.9 Melanoma in situ, unspecified from V24 HCC 12
D18.02 Hemangioma of intracranial structures from V24 HCC 12
D32.0 Benign neoplasm of cerebral meninges from V24 HCC 12
D32.1 Benign neoplasm of spinal meninges from V24 HCC 12
D32.9 Benign neoplasm of meninges, unspecified from V24 HCC 12
D33.0 Benign neoplasm of brain, supratentorial from V24 HCC 12
D33.1 Benign neoplasm of brain, infratentorial from V24 HCC 12
D33.2 Benign neoplasm of brain, unspecified from V24 HCC 12
D33.3 Benign neoplasm of cranial nerves from V24 HCC 12
D33.4 Benign neoplasm of spinal cord from V24 HCC 12
D33.7 Benign neoplasm of other specified parts of central nervous system from V24 HCC 12
D33.9 Benign neoplasm of central nervous system, unspecified from V24 HCC 12
D35.2 Benign neoplasm of pituitary gland from V24 HCC 12
D35.3 Benign neoplasm of craniopharyngeal duct from V24 HCC 12
D35.4 Benign neoplasm of pineal gland from V24 HCC 12
D42.0 Neoplasm of uncertain behavior of cerebral meninges from V24 HCC 12
D42.1 Neoplasm of uncertain behavior of spinal meninges from V24 HCC 12
D42.9 Neoplasm of uncertain behavior of meninges, unspecified from V24 HCC 12
D43.0 Neoplasm of uncertain behavior of brain, supratentorial from V24 HCC 12
D43.1 Neoplasm of uncertain behavior of brain, infratentorial from V24 HCC 12
D43.2 Neoplasm of uncertain behavior of brain, unspecified from V24 HCC 12
D43.3 Neoplasm of uncertain behavior of cranial nerves from V24 HCC 12
D43.4 Neoplasm of uncertain behavior of spinal cord from V24 HCC 12
D43.8 Neoplasm of uncertain behavior of other specified parts of central nervous system from V24 HCC 12
D43.9 Neoplasm of uncertain behavior of central nervous system, unspecified from V24 HCC 12
D44.3 Neoplasm of uncertain behavior of pituitary gland from V24 HCC 12
D44.4 Neoplasm of uncertain behavior of craniopharyngeal duct from V24 HCC 12
D44.5 Neoplasm of uncertain behavior of pineal gland from V24 HCC 12
D44.6 Neoplasm of uncertain behavior of carotid body from V24 HCC 12
D44.7 Neoplasm of uncertain behavior of aortic body and other paraganglia from V24 HCC 12
D45 Polycythemia vera from V24 HCC 48
D47.3 Essential (hemorrhagic) thrombocythemia from V24 HCC 48
D49.6 Neoplasm of unspecified behavior of brain from V24 HCC 12
Q85.00 Neurofibromatosis, unspecified from V24 HCC 12
Q85.01 Neurofibromatosis, type 1 from V24 HCC 12
Q85.02 Neurofibromatosis, type 2 from V24 HCC 12
Q85.03 Schwannomatosis from V24 HCC 12
Q85.09 Other neurofibromatosis from V24 HCC 12
Q85.1 Tuberous sclerosis from V24 HCC 12
Q85.81 PTEN hamartoma tumor syndrome from V24 HCC 12
Q85.82 Other Cowden syndrome from V24 HCC 12
Q85.83 Von Hippel-Lindau syndrome from V24 HCC 12
Q85.89 Other phakomatoses, not elsewhere classified from V24 HCC 12
Q85.9 Phakomatosis, unspecified from V24 HCC 12

Every code above carries the full HCC 23 weight when documented and reported on a Medicare Advantage encounter. The code link opens its full page with the complete risk adjustment card.

Questions About HCC 23

What is HCC 23 in the CMS-HCC model?

HCC 23 is CMS-HCC Category 23 (Prostate, Breast, and Other Cancers and Tumors) in the V28 risk adjustment model. It covers 234 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.

What is the RAF weight for HCC 23?

For payment year 2026, HCC 23 adds 0.186 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.186 to 0.237 across the seven payment segments shown above.

Which categories supersede HCC 23?

HCC 17 (Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic), HCC 18 (Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid), HCC 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers), HCC 20 (Lung and Other Severe Cancers), HCC 21 (Lymphoma and Other Cancers), and HCC 22 (Bladder, Colorectal, and Other Cancers) sit above HCC 23 in the hierarchy: when a beneficiary has diagnoses in both, only the more severe category is paid.

Related References

All HCC Categories HCC 17 Codes HCC 18 Codes HCC 19 Codes HCC 20 Codes HCC 21 Codes HCC 22 Codes V24 to V28: What Changed ICD-10-CM Code Lookup

Source: Centers for Medicare & Medicaid Services, Payment Year 2026 risk adjustment mapping and model software releases (CMS-HCC V28), applied to the FY 2026 ICD-10-CM code set. ICD List is not affiliated with CMS.