ICD-10 C7A.1
Billable / Specific HCC v28: 12Malignant poorly differentiated neuroendocrine tumors
About ICD-10-CM C7A.1
ICD-10-CM code C7A.1 represents Malignant poorly differentiated neuroendocrine tumors. This is a billable/specific code in the Neoplasms chapter (block C7A). The 2026 edition of ICD-10-CM C7A.1 became effective on October 1, 2025.
Coding Tips for C7A.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C7A.1 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 C7A.1. Per CMS ICD-10-CM Tabular 2026.
- Malignant poorly differentiated neuroendocrine tumor NOS
- Malignant poorly differentiated neuroendocrine carcinoma, any site
- High grade neuroendocrine carcinoma, any site
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 C7A.1
Local Coverage Determinations (LCDs) from CMS MACs that list C7A.1 as a covered diagnosis.
Showing top 10 of 811 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C7A.1.
5 Medicare
CPT Codes Commonly Billed with C7A.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- J2353 CMS LCD: Billing and Coding: Octreotide Acetate for Injectable Suspension (Sandostatin� LAR Depot) CMS LCD
Convert C7A.1 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 |
|---|---|---|
| C7A.1 | 20930 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C7A.1
Other codes in section C7A (Malignant neuroendocrine tumors).
ICD-10 C7A.1, Billing FAQ
Is ICD-10 code C7A.1 billable? +
Yes, C7A.1 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 C7A.1? +
ICD-10 C7A.1 includes: Malignant poorly differentiated neuroendocrine tumor NOS; Malignant poorly differentiated neuroendocrine carcinoma, any site; High grade neuroendocrine carcinoma, any site.
Does C7A.1 affect Medicare Advantage HCC risk adjustment? +
Yes. C7A.1 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C7A.1? +
Procedures frequently paired with C7A.1 include: J2353.
What ICD-9 codes does C7A.1 map to? +
Per CMS GEMs, C7A.1 maps to ICD-9 codes: 20930. 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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