Is C49.1 a billable ICD-10-CM code?

No. C49.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does C49.1 sit in the tabular list?

Neoplasms (C00-D49), in the block Malignant neoplasms of mesothelial and soft tissue (C45-C49).

What cannot be coded together with C49.1?

C49.1 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 C49.1 (C49) and apply to it just the same.

C49.1

C49.1 — Malignant neoplasm of connective and soft tissue of upper limb, including shoulder

Non-billable headerICD-10-CM

C49.1 is a non-billable header ICD-10-CM code for malignant neoplasm of connective and soft tissue of upper limb, including shoulder. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 inherited from the categories above C49.1

These are not written on C49.1, but they bind it: a note on a category applies to every code beneath it. Billing C49.1 with anything listed here is a denial.

Written on C49 — Malignant neoplasm of other connective and soft tissue

malignant neoplasm of cartilage (of):
articular (C40-C41)
larynx (C32.3)
nose (C30.0)
malignant neoplasm of connective tissue of breast (C50.-)

Excludes2 inherited from the categories above C49.1

Also inherited, and the opposite of Excludes1: these conditions are not part of C49.1, but a patient can have both, so you may code both.

Written on C49 — Malignant neoplasm of other connective and soft tissue

Kaposi's sarcoma of soft tissue (C46.1)
malignant neoplasm of heart (C38.0)
malignant neoplasm of peripheral nerves and autonomic nervous system (C47.-)
malignant neoplasm of peritoneum (C48.2)
malignant neoplasm of retroperitoneum (C48.0)
malignant neoplasm of uterine ligament (C57.3)
mesothelioma (C45.-)

Risk adjustment

C49.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code history

C49.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead C49.1

3 child codes. Green means billable.

Related codes at this level

Codes that share C49. If C49.1 is not quite right, the correct code is usually one of these.

Questions about C49.1

Is C49.1 a billable ICD-10-CM code?: No. C49.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does C49.1 sit in the tabular list?: Neoplasms (C00-D49), in the block Malignant neoplasms of mesothelial and soft tissue (C45-C49).
What cannot be coded together with C49.1?: C49.1 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 C49.1 (C49) and apply to it just the same.