ICD-10 C41.0
Billable / Specific HCC v28: 10 CCMalignant neoplasm of bones of skull and face
About ICD-10-CM C41.0
ICD-10-CM code C41.0 represents Malignant neoplasm of bones of skull and face. This is a billable/specific code in the Neoplasms chapter (block C41). The 2026 edition of ICD-10-CM C41.0 became effective on October 1, 2025.
Coding Tips for C41.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C41.0 is a CMS-HCC v28 risk-adjustment code (category 10). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
C41.0 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under C41.0. Per CMS ICD-10-CM Tabular 2026.
- Malignant neoplasm of maxilla (superior)
- Malignant neoplasm of orbital bone
Type 2 Excludes
Not included here, the excluded code is not part of C41.0, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- carcinoma, any type except intraosseous or odontogenic of:
- maxillary sinus (C31.0)
- upper jaw (C03.0)
- malignant neoplasm of jaw bone (lower) (C41.1)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Malignant neoplasm of bones of skull and face. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for C41.0
Local Coverage Determinations (LCDs) from CMS MACs that list C41.0 as a covered diagnosis.
Showing top 10 of 1,122 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C41.0.
2 Aetna
1 Cigna
5 Medicare
CPT Codes Commonly Billed with C41.0
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 11922 CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery CMS LCD
- 19369 CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery CMS LCD
- 11951 CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery CMS LCD
- 19357 CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery CMS LCD
- 19396 CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery CMS LCD
- 11921 CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery CMS LCD
- 15847 CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery CMS LCD
- 15824 CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery CMS LCD
- 30420 CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery CMS LCD
- 21235 CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery CMS LCD
Convert C41.0 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| C41.0 | 1700 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C41.0
Other codes in section C40-C41 (Malignant neoplasms of bone and articular cartilage).
ICD-10 C41.0, Billing FAQ
Is ICD-10 code C41.0 billable? +
Yes, C41.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to C41.0? +
ICD-10 C41.0 includes: Malignant neoplasm of maxilla (superior); Malignant neoplasm of orbital bone.
What codes are Type 2 Excludes for C41.0? +
Type 2 Excludes (may be coded together when both conditions exist): carcinoma, any type except intraosseous or odontogenic of:; maxillary sinus (C31.0); upper jaw (C03.0)
Does C41.0 affect Medicare Advantage HCC risk adjustment? +
Yes. C41.0 maps to CMS-HCC v28 category 10. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is C41.0 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with C41.0? +
Procedures frequently paired with C41.0 include: 11922, 19369, 11951, 19357, 19396.
What ICD-9 codes does C41.0 map to? +
Per CMS GEMs, C41.0 maps to ICD-9 codes: 1700. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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