ICD-10 C14.0
Billable / Specific HCC v28: 11Malignant neoplasm of pharynx, unspecified
About ICD-10-CM C14.0
ICD-10-CM code C14.0 represents Malignant neoplasm of pharynx, unspecified. This is a billable/specific code in the Neoplasms chapter (block C14). The 2026 edition of ICD-10-CM C14.0 became effective on October 1, 2025.
Coding Tips for C14.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C14.0 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 C14.0
Local Coverage Determinations (LCDs) from CMS MACs that list C14.0 as a covered diagnosis.
Showing top 10 of 627 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C14.0.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with C14.0
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 97130 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92608 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 97129 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92607 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 96110 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92524 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92508 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92597 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92521 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 96105 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
Convert C14.0 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 |
|---|---|---|
| C14.0 | 1490 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C14.0
Other codes in section C00-C14 (Malignant neoplasms of lip, oral cavity and pharynx).
ICD-10 C14.0, Billing FAQ
Is ICD-10 code C14.0 billable? +
Yes, C14.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does C14.0 affect Medicare Advantage HCC risk adjustment? +
Yes. C14.0 maps to CMS-HCC v28 category 11. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C14.0? +
Procedures frequently paired with C14.0 include: 97130, 92608, 97129, 92607, 96110.
What ICD-9 codes does C14.0 map to? +
Per CMS GEMs, C14.0 maps to ICD-9 codes: 1490. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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