ICD-10 C03.9
Billable / Specific HCC v28: 11Malignant neoplasm of gum, unspecified
About ICD-10-CM C03.9
ICD-10-CM code C03.9 represents Malignant neoplasm of gum, unspecified. This is a billable/specific code in the Neoplasms chapter (block C03). The 2026 edition of ICD-10-CM C03.9 became effective on October 1, 2025.
Coding Tips for C03.9
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C03.9 is a CMS-HCC v28 risk-adjustment code (category 11). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for C03.9
Local Coverage Determinations (LCDs) from CMS MACs that list C03.9 as a covered diagnosis.
Showing top 10 of 392 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C03.9.
1 Aetna
1 Cigna
5 Medicare
CPT Codes Commonly Billed with C03.9
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 63621 CMS LCD: Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) CMS LCD
- 61800 CMS LCD: Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) CMS LCD
- 77373 CMS LCD: Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) CMS LCD
- G0339 CMS LCD: Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) CMS LCD
- 77372 CMS LCD: Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) CMS LCD
- G0563 CMS LCD: Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) CMS LCD
- 77435 CMS LCD: Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) CMS LCD
- 77371 CMS LCD: Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) CMS LCD
- G0340 CMS LCD: Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) CMS LCD
- 61798 CMS LCD: Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) CMS LCD
Convert C03.9 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| C03.9 | 1438 | 10000 |
| C03.9 | 1439 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C03.9
Other codes in section C00-C14 (Malignant neoplasms of lip, oral cavity and pharynx).
ICD-10 C03.9, Billing FAQ
Is ICD-10 code C03.9 billable? +
Yes, C03.9 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does C03.9 affect Medicare Advantage HCC risk adjustment? +
Yes. C03.9 maps to CMS-HCC v28 category 11. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C03.9? +
Procedures frequently paired with C03.9 include: 63621, 61800, 77373, G0339, 77372.
What ICD-9 codes does C03.9 map to? +
Per CMS GEMs, C03.9 maps to ICD-9 codes: 1438, 1439. Useful for legacy data review and historical claim analysis.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team