C06.1
C06.1 — Malignant neoplasm of vestibule of mouth
Billable / specific codeICD-10-CM
C06.1 is a billable, specific ICD-10-CM code for malignant neoplasm of vestibule of mouth. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Malignant neoplasm of buccal sulcus (upper) (lower)
- Malignant neoplasm of labial sulcus (upper) (lower)
Risk adjustment
C06.1 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
C06.1 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 C06. If C06.1 is not quite right, the correct code is usually one of these.
Questions about C06.1
- Is C06.1 a billable ICD-10-CM code?
- Yes. C06.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does C06.1 sit in the tabular list?
- Neoplasms (C00-D49), in the block Malignant neoplasms of lip, oral cavity and pharynx (C00-C14).