C05.1
C05.1 — Malignant neoplasm of soft palate
Billable / specific codeICD-10-CM
C05.1 is a billable, specific ICD-10-CM code for malignant neoplasm of soft palate. It is valid for submission on a claim.
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- malignant neoplasm of nasopharyngeal surface of soft palate (C11.3)
Risk adjustment
C05.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 21 Lymphoma and Other Cancers0.671 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
C05.1 is named in 59 Medicare coverage policies — 59 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
- A52479Oral Anticancer Drugs - Policy Article
- A52479Oral Anticancer Drugs - Policy Article
- A52479Oral Anticancer Drugs - Policy Article
Related codes at this level
Codes that share C05. If C05.1 is not quite right, the correct code is usually one of these.
Questions about C05.1
- Is C05.1 a billable ICD-10-CM code?
- Yes. C05.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does C05.1 sit in the tabular list?
- Neoplasms (C00-D49), in the block Malignant neoplasms of lip, oral cavity and pharynx (C00-C14).