C61: Malignant neoplasm of prostate
C61 is a billable, specific ICD-10-CM code for malignant neoplasm of prostate. It is valid for submission on a claim.
Check C61 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- malignant neoplasm of seminal vesicle (C63.7)
Use additional code
Add a secondary code to capture the detail described below.
Risk adjustment
C61 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
C61 is named in 98 Medicare coverage policies: 98 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52370Billing and Coding: Bevacizumab and biosimilars
- A52399Billing and Coding: Denosumab (Prolia®, Xgeva®, Jubbonti®) and biosimilars
- A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
- A52453Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
Alphabetic index entries that lead here
- Adenocarcinoma›duct›unspecified site›male
- Carcinoma›endometrioid›unspecified site›male
- Cystadenocarcinoma›endometrioid›unspecified site›male
Code history
Unchanged in every release from FY2024 to FY2027.