C05.9: Malignant neoplasm of palate, unspecified

Risk adjustment

C05.9 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

C05.9 is named in 41 Medicare coverage policies: 41 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
• A52479Oral Anticancer Drugs - Policy Article
• A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
• A56621Billing and Coding: Swallowing Studies for Dysphagia