ICD-10 C43.111
Billable / Specific HCC v28: 12Malignant melanoma of right upper eyelid, including canthus
About ICD-10-CM C43.111
ICD-10-CM code C43.111 represents Malignant melanoma of right upper eyelid, including canthus. This is a billable/specific code in the Neoplasms chapter (block C43). The 2026 edition of ICD-10-CM C43.111 became effective on October 1, 2025.
Coding Tips for C43.111
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C43.111 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.
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 C43.111
Local Coverage Determinations (LCDs) from CMS MACs that list C43.111 as a covered diagnosis.
Showing top 10 of 1,764 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C43.111.
5 Medicare
CPT Codes Commonly Billed with C43.111
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 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
- 17283 CMS LCD: Billing and Coding: Destruction of Malignant Skin Lesions CMS LCD
- 17263 CMS LCD: Billing and Coding: Destruction of Malignant Skin Lesions CMS LCD
- 17260 CMS LCD: Billing and Coding: Destruction of Malignant Skin Lesions CMS LCD
Codes Adjacent To C43.111
Other codes in section C43-C44 (Melanoma and other malignant neoplasms of skin).
ICD-10 C43.111, Billing FAQ
Is ICD-10 code C43.111 billable? +
Yes, C43.111 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does C43.111 affect Medicare Advantage HCC risk adjustment? +
Yes. C43.111 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C43.111? +
Procedures frequently paired with C43.111 include: 17312, 17313, 17314, 17315, 81210.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team