ICD-10 C50.219
Billable / Specific HCC v28: 12Malignant neoplasm of upper-inner quadrant of unspecified female breast
About ICD-10-CM C50.219
ICD-10-CM code C50.219 represents Malignant neoplasm of upper-inner quadrant of unspecified female breast. This is a billable/specific code in the chapter (block C50). The 2026 edition of ICD-10-CM C50.219 became effective on October 1, 2025.
Coding Tips for C50.219
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C50.219 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 C50.219
Local Coverage Determinations (LCDs) from CMS MACs that list C50.219 as a covered diagnosis.
Showing top 10 of 976 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C50.219.
5 Medicare
Convert C50.219 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 |
|---|---|---|
| C50.219 | 1742 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C50.219
Other codes in section C50 (Malignant neoplasms of breast).
ICD-10 C50.219, Billing FAQ
Is ICD-10 code C50.219 billable? +
Yes, C50.219 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does C50.219 affect Medicare Advantage HCC risk adjustment? +
Yes. C50.219 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C50.219? +
Procedures frequently paired with C50.219 include: 0155U, 81309.
What ICD-9 codes does C50.219 map to? +
Per CMS GEMs, C50.219 maps to ICD-9 codes: 1742. Useful for legacy data review and historical claim analysis.
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