C05.2
BillableMalignant neoplasm of uvula
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C05.2 an HCC code?
Yes. C05.2 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model (and Colorectal, Bladder, and Other Cancers under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for C05.2
For C05.2to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed C05.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C05.2 is the ICD-10-CM diagnosis code for malignant neoplasm of uvula. Cancer that develops in the uvula, the small tissue projection hanging from the back of the soft palate. C05.2 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of lip, oral cavity and pharynx (c00-c14).
Under the CMS-HCC V28 risk adjustment model, C05.2 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors (HCC 21) with a community, non-dual, aged base RAF weight of 0.545. Under the older CMS-HCC V24 model, C05.2 maps to Colorectal, Bladder, and Other Cancers (HCC 11) with a community, non-dual, aged base RAF weight of 0.306. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Uvula cancers are relatively rare; verify documentation carefully. Because C05.2 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for C05.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Uvula cancers are relatively rare; verify documentation carefully
- •Note any extension to soft palate or pharynx if present
Clinical Significance
Malignant neoplasm of the uvula is a rare oral cancer affecting the small pendulous tissue at the posterior edge of the soft palate. Its rarity makes accurate documentation essential, and because the uvula is small, cancers here almost always extend to the soft palate or oropharynx, requiring careful assessment of true origin site.
Documentation Requirements
- ✓Pathology-confirmed malignancy with biopsy from uvula tissue
- ✓Documentation clearly identifying uvula as the primary site
- ✓Assessment of extension to soft palate and oropharyngeal structures
- ✓TNM staging including depth of invasion
- ✓Provider confirmation that the primary origin is uvula rather than adjacent soft palate or oropharynx
Commonly Confused Codes
- •C05.1 — Malignant neoplasm of soft palate; the uvula is anatomically connected to the soft palate, and origin may be difficult to distinguish
- •C05.8 — Overlapping sites of palate; use when tumor involves both uvula and soft palate
- •C10.9 — Oropharynx, unspecified; uvular tumors may be misclassified as oropharyngeal cancers
- •C09.0 — Tonsillar fossa; adjacent site that may be confused with uvular origin