ICD-10 C54.0
Billable / Specific HCC v28: 12Malignant neoplasm of isthmus uteri
About ICD-10-CM C54.0
ICD-10-CM code C54.0 represents Malignant neoplasm of isthmus uteri. This is a billable/specific code in the chapter (block C54). The 2026 edition of ICD-10-CM C54.0 became effective on October 1, 2025.
Coding Tips for C54.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C54.0 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under C54.0. Per CMS ICD-10-CM Tabular 2026.
- Malignant neoplasm of lower uterine segment
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 C54.0
Local Coverage Determinations (LCDs) from CMS MACs that list C54.0 as a covered diagnosis.
Showing top 10 of 945 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C54.0.
5 Medicare
CPT Codes Commonly Billed with C54.0
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
Convert C54.0 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 |
|---|---|---|
| C54.0 | 1821 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C54.0
Other codes in section C51-C58 (Malignant neoplasms of female genital organs).
ICD-10 C54.0, Billing FAQ
Is ICD-10 code C54.0 billable? +
Yes, C54.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to C54.0? +
ICD-10 C54.0 includes: Malignant neoplasm of lower uterine segment.
Does C54.0 affect Medicare Advantage HCC risk adjustment? +
Yes. C54.0 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C54.0? +
Procedures frequently paired with C54.0 include: C9726, 19294, 76145, 77469, 77425.
What ICD-9 codes does C54.0 map to? +
Per CMS GEMs, C54.0 maps to ICD-9 codes: 1821. 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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