ICD-10 Q38
Non-Billable HeaderOther congenital malformations of tongue, mouth and pharynx
About ICD-10-CM Q38
ICD-10-CM code Q38 represents Other congenital malformations of tongue, mouth and pharynx. This is a non-billable header code in the Congenital Malformations chapter (block Q38). The 2026 edition of ICD-10-CM Q38 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Type 1 Excludes
Pure excludes, these codes can never be coded together with Q38. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- dentofacial anomalies (M26.-)
- macrostomia (Q18.4)
- microstomia (Q18.5)
Medicare LCD Coverage for Q38
Local Coverage Determinations (LCDs) from CMS MACs that list Q38 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing Q38.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but Q38 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with Q38
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.
Codes Adjacent To Q38
Other codes in section Q38-Q45 (Other congenital malformations of the digestive system).
ICD-10 Q38, Billing FAQ
Is ICD-10 code Q38 billable? +
No, Q38 is a non-billable header code. Use a more specific child code from block Q38 when submitting claims.
What codes are Type 1 Excludes for Q38? +
Type 1 Excludes (never code together with Q38): dentofacial anomalies (M26.-); macrostomia (Q18.4); microstomia (Q18.5)
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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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