October 1 update. Our PDGM and ICD-10 tools now use the FY2027 code set: 190 codes added, 30 deleted, and no existing code changed clinical group.

See what changed

ICD-10 · PDGM grouping

C09 Malignant neoplasm of tonsil

All 4 codes in the C09 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.

ICD-10-CM FY2027 · CMS grouper v07.2.26

Codes in family

4

Can lead a claim

4

Cannot lead a claim

0

What CMS assigns to C09

All 4 codes group to MMTA - Infectious Disease, Neoplasms, and Blood-Forming Diseases. All 4 count toward the Malignant neoplasm of Lip, Oral cavity and Pharynx, includes Head and Neck Cancers comorbidity subgroup. Every code can lead a claim.

  • Malignant neoplasm of Lip, Oral cavity and Pharynx, includes Head and Neck Cancers

Every code in C09

Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.

CodeDescriptionPrimary positionClinical groupComorbidity subgroup
C09.0Malignant neoplasm of tonsillar fossaCan lead a claimKMalignant neoplasm of Lip, Oral cavity and Pharynx, includes Head and Neck Cancers
C09.1Malignant neoplasm of tonsillar pillar (anterior) (posterior)CMS: Malig neoplasm of tonsillar pillar (anterior) (posterior)Can lead a claimKMalignant neoplasm of Lip, Oral cavity and Pharynx, includes Head and Neck Cancers
C09.8Malignant neoplasm of overlapping sites of tonsilCan lead a claimKMalignant neoplasm of Lip, Oral cavity and Pharynx, includes Head and Neck Cancers
C09.9Malignant neoplasm of tonsil, unspecifiedCan lead a claimKMalignant neoplasm of Lip, Oral cavity and Pharynx, includes Head and Neck Cancers

Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.

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