ICD-10 C30.1
Billable / Specific HCC v28: 11Malignant neoplasm of middle ear
About ICD-10-CM C30.1
ICD-10-CM code C30.1 represents Malignant neoplasm of middle ear. This is a billable/specific code in the Neoplasms chapter (block C30). The 2026 edition of ICD-10-CM C30.1 became effective on October 1, 2025.
Coding Tips for C30.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C30.1 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under C30.1. Per CMS ICD-10-CM Tabular 2026.
- Malignant neoplasm of antrum tympanicum
- Malignant neoplasm of auditory tube
- Malignant neoplasm of eustachian tube
- Malignant neoplasm of inner ear
- Malignant neoplasm of mastoid air cells
- Malignant neoplasm of tympanic cavity
Type 1 Excludes
Pure excludes, these codes can never be coded together with C30.1. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- malignant neoplasm of auricular canal (external) (C43.2-,C44.2-)
- malignant neoplasm of bone of ear (meatus) (C41.0)
- malignant neoplasm of cartilage of ear (C49.0)
- malignant melanoma of skin of (external) ear (C43.2-)
- other and unspecified malignant neoplasm of skin of (external) ear (C44.2-)
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 C30.1
Local Coverage Determinations (LCDs) from CMS MACs that list C30.1 as a covered diagnosis.
Showing top 10 of 880 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C30.1.
5 Medicare
CPT Codes Commonly Billed with C30.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert C30.1 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 |
|---|---|---|
| C30.1 | 1601 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C30.1
Other codes in section C30-C39 (Malignant neoplasms of respiratory and intrathoracic organs).
ICD-10 C30.1, Billing FAQ
Is ICD-10 code C30.1 billable? +
Yes, C30.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to C30.1? +
ICD-10 C30.1 includes: Malignant neoplasm of antrum tympanicum; Malignant neoplasm of auditory tube; Malignant neoplasm of eustachian tube, and 3 more clinical synonyms.
What codes are Type 1 Excludes for C30.1? +
Type 1 Excludes (never code together with C30.1): malignant neoplasm of auricular canal (external) (C43.2-,C44.2-); malignant neoplasm of bone of ear (meatus) (C41.0); malignant neoplasm of cartilage of ear (C49.0)
Does C30.1 affect Medicare Advantage HCC risk adjustment? +
Yes. C30.1 maps to CMS-HCC v28 category 11. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does C30.1 map to? +
Per CMS GEMs, C30.1 maps to ICD-9 codes: 1601. 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 June 1, 2026.
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