Is C26.1 a billable ICD-10-CM code?

Yes. C26.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does C26.1 sit in the tabular list?

Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).

What cannot be coded together with C26.1?

C26.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above C26.1 (C26) and apply to it just the same.

C26.1

C26.1 — Malignant neoplasm of spleen

Billable / specific codeICD-10-CM

C26.1 is a billable, specific ICD-10-CM code for malignant neoplasm of spleen. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

Hodgkin lymphoma (C81.-)
non-Hodgkin lymphoma (C82-C85)

Excludes1 inherited from the categories above C26.1

These are not written on C26.1, but they bind it: a note on a category applies to every code beneath it. Billing C26.1 with anything listed here is a denial.

Written on C26 — Malignant neoplasm of other and ill-defined digestive organs

malignant neoplasm of peritoneum and retroperitoneum (C48.-)

Risk adjustment

C26.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 22 Bladder, Colorectal, and Other Cancers0.363 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

C26.1 is named in 55 Medicare coverage policies — 55 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52479Oral Anticancer Drugs - Policy Article
A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
A54768Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy
A55717Billing and Coding: Lab: Flow Cytometry

Code history

C26.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share C26. If C26.1 is not quite right, the correct code is usually one of these.

Questions about C26.1

Is C26.1 a billable ICD-10-CM code?: Yes. C26.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does C26.1 sit in the tabular list?: Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).
What cannot be coded together with C26.1?: C26.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above C26.1 (C26) and apply to it just the same.