D16.5 ICD-10-CM Code: Benign neoplasm of lower jaw bone
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Neoplasms (C00-D49) / Benign neoplasms, except benign neuroendocrine tumors (D10-D36)
D16.5
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBenign neoplasm of lower jaw bone
A noncancerous tumor of the lower jaw bone (mandible).
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Keratocyst of mandible
- Keratocystic odontogenic tumor of mandible
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for D16.5 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for D16.5 in this effective period.
Excludes 1
Official- benign neoplasm of connective tissue of ear (D21.0)
- benign neoplasm of connective tissue of eyelid (D21.0)
- benign neoplasm of connective tissue of larynx (D14.1)
- benign neoplasm of connective tissue of nose (D14.0)
- benign neoplasm of synovia (D21.-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D16.5 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D16.5 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D16.5 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is D16.5 an HCC code?
No. D16.5 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- D16.5
- Description
- Benign neoplasm of lower jaw bone
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
D16.5 is the ICD-10-CM diagnosis code for benign neoplasm of lower jaw bone. A noncancerous tumor of the lower jaw bone (mandible). D16.5 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering benign neoplasms, except benign neuroendocrine tumors (d10-d36).
D16.5 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code is specific to the mandible; do not use for upper jaw (maxilla) which falls under D16.4.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D16.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is specific to the mandible; do not use for upper jaw (maxilla) which falls under D16.4
- •Common benign tumors of the mandible include osteomas and odontogenic tumors