ICD-10 C61
Billable / Specific HCC v28: 12Malignant neoplasm of prostate
About ICD-10-CM C61
ICD-10-CM code C61 represents Malignant neoplasm of prostate. This is a billable/specific code in the chapter (block C61). The 2026 edition of ICD-10-CM C61 became effective on October 1, 2025.
Coding Tips for C61
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C61 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.
Type 1 Excludes
Pure excludes, these codes can never be coded together with C61. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- malignant neoplasm of seminal vesicle (C63.7)
Use Additional Code
When coding C61, also report these additional codes when applicable.
- code, if applicable, to identify:
- hormone sensitivity status (Z19.1-Z19.2)
- rising PSA following treatment for malignant neoplasm of prostate (R97.21)
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 C61
Local Coverage Determinations (LCDs) from CMS MACs that list C61 as a covered diagnosis.
Showing top 10 of 1,514 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C61.
2 Aetna
1 Cigna
5 Medicare
CPT Codes Commonly Billed with C61
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 55700 Prostate biopsy — elevated PSA, BPH, prostate cancer Urology
- 55700 Prostate biopsy — elevated PSA, prostate disorder, prostate cancer, family hx prostate cancer, urinary retention, prostate screening Urology
- 81542 CMS LCD: Billing and Coding: MolDX: Gene Expression Profile Tests for Decision-Making in Castration Resistant and Metastatic Prostate Cancers CMS LCD
- 0047U CMS LCD: Billing and Coding: MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease CMS LCD
- 81541 CMS LCD: Billing and Coding: MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease CMS LCD
- 76770 CMS LCD: Billing and Coding: Retroperitoneal Ultrasound CMS LCD
- 76776 CMS LCD: Billing and Coding: Retroperitoneal Ultrasound CMS LCD
- 76775 CMS LCD: Billing and Coding: Retroperitoneal Ultrasound CMS LCD
- Q5158 CMS LCD: Billing and Coding: Denosumab (Prolia�, Xgeva�, Jubbonti�, Wyost�, Ospomyv�,Xbryk�,Bomyntra�, Conexxence�, Stoboclo�, Osenvelt�,Bildyos�, Bilprevda�) CMS LCD
- Q5157 CMS LCD: Billing and Coding: Denosumab (Prolia�, Xgeva�, Jubbonti�, Wyost�, Ospomyv�,Xbryk�,Bomyntra�, Conexxence�, Stoboclo�, Osenvelt�,Bildyos�, Bilprevda�) CMS LCD
Convert C61 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 |
|---|---|---|
| C61 | 185 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C61
Other codes in section C60-C63 (Malignant neoplasms of male genital organs).
ICD-10 C61, Billing FAQ
Is ICD-10 code C61 billable? +
Yes, C61 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for C61? +
Type 1 Excludes (never code together with C61): malignant neoplasm of seminal vesicle (C63.7)
Does C61 affect Medicare Advantage HCC risk adjustment? +
Yes. C61 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C61? +
Procedures frequently paired with C61 include: 55700, 55700, 81542, 0047U, 81541.
What ICD-9 codes does C61 map to? +
Per CMS GEMs, C61 maps to ICD-9 codes: 185. 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 July 16, 2026.
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