C54.1
C54.1: Malignant neoplasm of endometrium
Billable / specific codeICD-10-CM
C54.1 is a billable, specific ICD-10-CM code for malignant neoplasm of endometrium. It is valid for submission on a claim.
Check C54.1 with the rest of the claim: free scrubberOther codes that can never be billed with C54.1
Their own Excludes1 notes name this code, so the conflict is not listed above.
- N85.02Endometrial intraepithelial neoplasia [EIN]
Risk adjustment
C54.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 23 Prostate, Breast, and Other Cancers and Tumors0.186 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
C54.1 is named in 64 Medicare coverage policies: 64 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52370Billing and Coding: Bevacizumab and biosimilars
- A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
- A52479Oral Anticancer Drugs - Policy Article
- A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
Alphabetic index entries that lead here
- Sarcoma›endometrial(stromal)
- Sarcoma›stromal(endometrial)
Code history
Unchanged in every release from FY2024 to FY2027.