ICD-10 C43.0
Billable / Specific HCC v28: 12Malignant melanoma of lip
About ICD-10-CM C43.0
ICD-10-CM code C43.0 represents Malignant melanoma of lip. This is a billable/specific code in the Neoplasms chapter (block C43). The 2026 edition of ICD-10-CM C43.0 became effective on October 1, 2025.
Coding Tips for C43.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C43.0 is a CMS-HCC v28 risk-adjustment code (category 12). 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.
Type 1 Excludes
Pure excludes, these codes can never be coded together with C43.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- malignant neoplasm of vermilion border of lip (C00.0-C00.2)
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.
Medicare LCD Coverage for C43.0
Local Coverage Determinations (LCDs) from CMS MACs that list C43.0 as a covered diagnosis.
Showing top 10 of 1,718 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C43.0.
2 Aetna
1 Cigna
5 Medicare
CPT Codes Commonly Billed with C43.0
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 17000 Destruction of skin lesion Dermatology
- 17110 Excision of skin lesion Dermatology
- 17003 Destruction of skin lesion with cryotherapy Dermatology
- 17312 CMS LCD: Billing and Coding: Mohs Micrographic Surgery CMS LCD
- 17313 CMS LCD: Billing and Coding: Mohs Micrographic Surgery CMS LCD
- 17314 CMS LCD: Billing and Coding: Mohs Micrographic Surgery CMS LCD
- 17315 CMS LCD: Billing and Coding: Mohs Micrographic Surgery CMS LCD
- 81210 CMS LCD: Billing and Coding: MolDX: FDA-Approved BRAF Tests CMS LCD
- 17272 CMS LCD: Billing and Coding: Destruction of Malignant Skin Lesions CMS LCD
- 17280 CMS LCD: Billing and Coding: Destruction of Malignant Skin Lesions CMS LCD
Convert C43.0 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 |
|---|---|---|
| C43.0 | 1720 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C43.0
Other codes in section C43-C44 (Melanoma and other malignant neoplasms of skin).
ICD-10 C43.0, Billing FAQ
Is ICD-10 code C43.0 billable? +
Yes, C43.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for C43.0? +
Type 1 Excludes (never code together with C43.0): malignant neoplasm of vermilion border of lip (C00.0-C00.2)
Does C43.0 affect Medicare Advantage HCC risk adjustment? +
Yes. C43.0 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C43.0? +
Procedures frequently paired with C43.0 include: 17000, 17110, 17003, 17312, 17313.
What ICD-9 codes does C43.0 map to? +
Per CMS GEMs, C43.0 maps to ICD-9 codes: 1720. 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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