ICD-10 C50.919
Billable / Specific HCC v28: 12Malignant neoplasm of unspecified site of unspecified female breast
About ICD-10-CM C50.919
ICD-10-CM code C50.919 represents Malignant neoplasm of unspecified site of unspecified female breast. This is a billable/specific code in the chapter (block C50). The 2026 edition of ICD-10-CM C50.919 became effective on October 1, 2025.
Coding Tips for C50.919
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C50.919 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 C50.919
Local Coverage Determinations (LCDs) from CMS MACs that list C50.919 as a covered diagnosis.
Showing top 10 of 1,066 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C50.919.
1 Aetna
5 Medicare
CPT Codes Commonly Billed with C50.919
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 99205 New patient office visit — complex/high-risk: uncontrolled diabetes, heart failure, COPD exacerbation, cancer, MS, RA, CKD, CAD, recurrent depression, epilepsy, lupus, syncope, cognitive decline Primary Care
- 99215 Established patient — high complexity: HF exacerbation, COPD exacerbation, cancer management, MS, advanced CKD, uncontrolled diabetes, recurrent syncope, respiratory failure, liver cirrhosis Primary Care
Convert C50.919 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 |
|---|---|---|
| C50.919 | 1749 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C50.919
Other codes in section C50 (Malignant neoplasms of breast).
ICD-10 C50.919, Billing FAQ
Is ICD-10 code C50.919 billable? +
Yes, C50.919 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does C50.919 affect Medicare Advantage HCC risk adjustment? +
Yes. C50.919 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C50.919? +
Procedures frequently paired with C50.919 include: 99205, 99215.
What ICD-9 codes does C50.919 map to? +
Per CMS GEMs, C50.919 maps to ICD-9 codes: 1749. 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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