ICD-10 C67.5
Billable / Specific HCC v28: 11Malignant neoplasm of bladder neck
About ICD-10-CM C67.5
ICD-10-CM code C67.5 represents Malignant neoplasm of bladder neck. This is a billable/specific code in the chapter (block C67). The 2026 edition of ICD-10-CM C67.5 became effective on October 1, 2025.
Coding Tips for C67.5
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C67.5 is a CMS-HCC v28 risk-adjustment code (category 11). 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 C67.5. Per CMS ICD-10-CM Tabular 2026.
- Malignant neoplasm of internal urethral orifice
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 C67.5
Local Coverage Determinations (LCDs) from CMS MACs that list C67.5 as a covered diagnosis.
Showing top 10 of 1,052 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C67.5.
5 Medicare
CPT Codes Commonly Billed with C67.5
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 88120 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
- 86386 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
- 86294 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
- 86316 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
- 88121 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
- 76873 CMS LCD: Billing and Coding: Transrectal Ultrasound CMS LCD
- 76872 CMS LCD: Billing and Coding: Transrectal Ultrasound CMS LCD
Convert C67.5 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 |
|---|---|---|
| C67.5 | 1885 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C67.5
Other codes in section C64-C68 (Malignant neoplasms of urinary tract).
ICD-10 C67.5, Billing FAQ
Is ICD-10 code C67.5 billable? +
Yes, C67.5 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 C67.5? +
ICD-10 C67.5 includes: Malignant neoplasm of internal urethral orifice.
Does C67.5 affect Medicare Advantage HCC risk adjustment? +
Yes. C67.5 maps to CMS-HCC v28 category 11. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C67.5? +
Procedures frequently paired with C67.5 include: 88120, 86386, 86294, 86316, 88121.
What ICD-9 codes does C67.5 map to? +
Per CMS GEMs, C67.5 maps to ICD-9 codes: 1885. 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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