ICD-10 C43.61
Billable / Specific HCC v28: 12Malignant melanoma of right upper limb, including shoulder
About ICD-10-CM C43.61
ICD-10-CM code C43.61 represents Malignant melanoma of right upper limb, including shoulder. This is a billable/specific code in the Neoplasms chapter (block C43). The 2026 edition of ICD-10-CM C43.61 became effective on October 1, 2025.
Coding Tips for C43.61
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C43.61 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 C43.61
Local Coverage Determinations (LCDs) from CMS MACs that list C43.61 as a covered diagnosis.
Showing top 10 of 1,587 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C43.61.
5 Medicare
CPT Codes Commonly Billed with C43.61
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
Convert C43.61 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 |
|---|---|---|
| C43.61 | 1726 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C43.61
Other codes in section C43-C44 (Melanoma and other malignant neoplasms of skin).
ICD-10 C43.61, Billing FAQ
Is ICD-10 code C43.61 billable? +
Yes, C43.61 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does C43.61 affect Medicare Advantage HCC risk adjustment? +
Yes. C43.61 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C43.61? +
Procedures frequently paired with C43.61 include: 17312, 17313, 17314, 17315, 81210.
What ICD-9 codes does C43.61 map to? +
Per CMS GEMs, C43.61 maps to ICD-9 codes: 1726. 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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