C25.1
C25.1 — Malignant neoplasm of body of pancreas
Billable / specific codeICD-10-CM
C25.1 is a billable, specific ICD-10-CM code for malignant neoplasm of body of pancreas. It is valid for submission on a claim.
Risk adjustment
C25.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 20 Lung and Other Severe Cancers1.136 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
C25.1 is named in 90 Medicare coverage policies — 90 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
- A52479Oral Anticancer Drugs - Policy Article
- A52479Oral Anticancer Drugs - Policy Article
- A52479Oral Anticancer Drugs - Policy Article
Related codes at this level
Codes that share C25. If C25.1 is not quite right, the correct code is usually one of these.
- C25.0Malignant neoplasm of head of pancreas
- C25.2Malignant neoplasm of tail of pancreas
- C25.3Malignant neoplasm of pancreatic duct
- C25.4Malignant neoplasm of endocrine pancreas
- C25.7Malignant neoplasm of other parts of pancreas
- C25.8Malignant neoplasm of overlapping sites of pancreas
- C25.9Malignant neoplasm of pancreas, unspecified
Questions about C25.1
- Is C25.1 a billable ICD-10-CM code?
- Yes. C25.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does C25.1 sit in the tabular list?
- Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).