C14.2
BillableMalignant neoplasm of Waldeyer's ring
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C14.2 an HCC code?
Yes. C14.2 maps to Lymphoma and Other Cancers 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 C14.2
For C14.2to 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 C14.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C14.2 is the ICD-10-CM diagnosis code for malignant neoplasm of waldeyer's ring. Cancer that develops in Waldeyer's ring, which is a collection of lymphoid tissue in the back of the throat including the tonsils and adenoids. C14.2 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, C14.2 maps to Lymphoma and Other Cancers (HCC 21) with a community, non-dual, aged base RAF weight of 0.671. Under the older CMS-HCC V24 model, C14.2 maps to Colorectal, Bladder, and Other Cancers (HCC 11) with a community, non-dual, aged base RAF weight of 0.307. 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.
Waldeyer's ring includes palatine tonsils, pharyngeal tonsil, and lingual tonsil; verify the specific site if documented. Because C14.2 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 C14.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Waldeyer's ring includes palatine tonsils, pharyngeal tonsil, and lingual tonsil; verify the specific site if documented
- •Do not use this code if the cancer is specifically limited to one component (use specific tonsil codes instead)
Clinical Significance
Malignant neoplasm of Waldeyer's ring describes cancer involving the ring of lymphoid tissue in the pharynx (palatine tonsils, pharyngeal tonsil/adenoid, lingual tonsil, and tubal tonsils). This code is used when the lymphoma or carcinoma involves the ring as a whole rather than a single component, and it is particularly associated with non-Hodgkin lymphoma.
Documentation Requirements
- ✓Pathology-confirmed malignancy specifying Waldeyer's ring involvement
- ✓Histological type (lymphoma vs carcinoma, with specific lymphoma subtype if applicable)
- ✓Documentation showing involvement of multiple components of Waldeyer's ring
- ✓Evidence that a single component (tonsil, adenoid, etc.) is not the sole primary site
- ✓PET/CT for staging if lymphoma is confirmed
Commonly Confused Codes
- •C09.9 — Tonsil, unspecified; use when cancer is limited to the palatine tonsils
- •C11.1 — Posterior wall of nasopharynx; adenoid/pharyngeal tonsil is a component of Waldeyer's ring but has its own code
- •C01 — Base of tongue; lingual tonsil is part of Waldeyer's ring but tongue base has its own code
- •C83.xx or C84.xx — Specific non-Hodgkin lymphoma codes; lymphoma of Waldeyer's ring requires both site and lymphoma type codes