ICD-10 C50.A1
Billable / Specific HCC v28: 12Malignant inflammatory neoplasm of right breast
About ICD-10-CM C50.A1
ICD-10-CM code C50.A1 represents Malignant inflammatory neoplasm of right breast. This is a billable/specific code in the chapter (block C50). The 2026 edition of ICD-10-CM C50.A1 became effective on October 1, 2025.
Coding Tips for C50.A1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C50.A1 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.A1
Local Coverage Determinations (LCDs) from CMS MACs that list C50.A1 as a covered diagnosis.
Showing top 10 of 1,028 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C50.A1.
5 Medicare
CPT Codes Commonly Billed with C50.A1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- C9726 CMS LCD: Billing and Coding: Intraoperative Radiation Therapy CMS LCD
- 19294 CMS LCD: Billing and Coding: Intraoperative Radiation Therapy CMS LCD
- 76145 CMS LCD: Billing and Coding: Intraoperative Radiation Therapy CMS LCD
- 77469 CMS LCD: Billing and Coding: Intraoperative Radiation Therapy CMS LCD
- 77425 CMS LCD: Billing and Coding: Intraoperative Radiation Therapy CMS LCD
- 77424 CMS LCD: Billing and Coding: Intraoperative Radiation Therapy CMS LCD
- J1952 CMS LCD: Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs CMS LCD
- J3316 CMS LCD: Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs CMS LCD
- 96402 CMS LCD: Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs CMS LCD
- J9219 CMS LCD: Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs CMS LCD
Codes Adjacent To C50.A1
Other codes in section C50 (Malignant neoplasms of breast).
ICD-10 C50.A1, Billing FAQ
Is ICD-10 code C50.A1 billable? +
Yes, C50.A1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does C50.A1 affect Medicare Advantage HCC risk adjustment? +
Yes. C50.A1 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.A1? +
Procedures frequently paired with C50.A1 include: C9726, 19294, 76145, 77469, 77425.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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