Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesMalignant neoplasms of lip, oral cavity and pharynxICD-10-CM c09-malignant-neoplasm-of-tonsil
    Ask Trek AI about this page

    ICD-10-CM Code For Malignant Neoplasm Of Tonsil: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group C09 includes malignant neoplasms of the tonsil, covering cancers originating in the palatine tonsils and adjacent tonsillar tissue, including specified laterality when documented. These ICD-10-CM diagnosis codes are used to document primary tonsillar malignancy presentations, capturing tumor location, laterality, and clinical complexity relevant to head and neck cancer care. Accurate coding within the ICD-10-CM C09 group supports complete clinical documentation, proper claim adjudication, and appropriate reimbursement.

    Customize your policy alerts

    Sign up for ICD-10-CM Code For Malignant Neoplasm Of Tonsil: Group Overview policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    ICD-10-CM C09: Malignant Neoplasm Of Tonsil Overview

    The ICD-10-CM C09 group represents malignant tumors originating in the tonsillar tissue, part of the oropharynx. These diagnoses target cancers of the palatine tonsils and related tonsillar structures within the head and neck region. Accurate coding is essential for clinical documentation, staging, and appropriate reimbursement for cancer care services.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    When to Use

    Use a code from this group when medical documentation indicates a primary malignant tumor of the tonsil, including specified laterality or unspecified site within the tonsil. Codes are applied for initial diagnoses, cancer staging documentation, and encounters related to management of tonsillar malignancy.

    ICD-10-CM Codes

    4 rows

    ICD-10-CM CodeDescription
    C09.0Malignant neoplasm of tonsillar fossa
    C09.1Malignant neoplasm of tonsillar pillar (anterior) (posterior)
    C09.8Malignant neoplasm of overlapping sites of tonsil
    C09.9Malignant neoplasm of tonsil, unspecified

    DRG Codes

    6 rows

    DRG CodeDescription
    011Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC
    012Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC
    013Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC
    146Ear, Nose, Mouth and Throat Malignancy with MCC
    147Ear, Nose, Mouth and Throat Malignancy with CC
    148Ear, Nose, Mouth and Throat Malignancy without CC/MCC

    Typical Clinical Scenarios

    • An adult in their 60s with a several-month history of a unilateral sore throat, progressive odynophagia, and an enlarging lateral pharyngeal mass on exam presents for evaluation; flexible laryngoscopy and biopsy confirm squamous cell carcinoma originating in the palatine tonsil. This is an initial presentation of a primary tonsillar malignancy where the clinician assigns a code for localized malignant neoplasm of the tonsil. Typical codes: C09.0, C09.1
    • A middle-aged patient with known tonsillar cancer treated previously with radiation and neck dissection returns for surveillance and is found on imaging and exam to have persistent regional disease confined to the tonsillar region without specification of laterality. Surveillance visit documents recurrent or persistent malignant neoplasm of the tonsil, prompting assignment of a tonsil malignancy code to capture ongoing disease status. Typical codes: C09.8, C09.9
    • An elderly patient presents to the emergency department with acute airway compromise and bleeding from a necrotic tonsillar tumor, with biopsy-proven malignancy and suspicion of local invasion causing obstructive symptoms. This acute complication of a known tonsillar malignancy requires coding for the malignant neoplasm of the tonsil while the patient receives urgent management for hemorrhage and airway protection. Typical codes: C09.8, C09.9

    Related Codes

    C00-MALIGNANT-NEOPLASM-OF-LIP

    ICD-10-CM Code For Malignant Neoplasm Of Lip: Group Overview

    C01-MALIGNANT-NEOPLASM-BASE-OF-TONGUE

    ICD-10-CM Code For Malignant Neoplasm Of Base Of Tongue: Group Overview

    C02-MALIGNANT-NEOPLASM-OF-TONGUE

    ICD-10-CM Code For Malignant Neoplasm Of Other And Unspecified Parts Of Tongue: Group Overview

    C03-MALIGNANT-NEOPLASM-OF-GUM

    ICD-10-CM Code For Malignant Neoplasm Of Gum: Group Overview

    C04-MALIGNANT-NEOPLASM-OF-FLOOR-OF-MOUTH

    ICD-10-CM Code For Malignant Neoplasm Of Floor Of Mouth: Group Overview

    C05-MALIGNANT-NEOPLASM-OF-PALATE

    ICD-10-CM Code For Malignant Neoplasm Of Palate: Group Overview

    C06-MALIGNANT-NEOPLASM-OF-MOUTH

    ICD-10-CM Code For Malignant Neoplasm Of Other And Unspecified Parts Of Mouth: Group Overview

    C07-MALIGNANT-NEOPLASM-OF-PAROTID-GLAND

    ICD-10-CM Code For Malignant Neoplasm Of Parotid Gland: Group Overview

    C08-MALIGNANT-SALIVARY-GLAND-NEOPLASMS

    ICD-10-CM Code For Malignant Neoplasm Of Other And Unspecified Major Salivary Glands: Group Overview

    C10-MALIGNANT-NEOPLASM-OF-OROPHARYNX

    ICD-10-CM Code For Malignant Neoplasm Of Oropharynx: Group Overview

    Showing 1–10 of 14

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.