Question 1

What is ICD-10 code D37.031?

Accepted Answer

D37.031 is the ICD-10-CM diagnosis code for neoplasm of uncertain behavior of the sublingual salivary glands. A growth in the sublingual salivary glands (small salivary glands under the tongue) with uncertain behavior requiring further evaluation. D37.031 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (d37-d48).

D37.031 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.

The fifth character '1' specifies sublingual glands; verify the exact salivary gland location in clinical documentation.

Question 2

Is D37.031 an HCC code?

Accepted Answer

No. D37.031 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is D37.031 billable?

Accepted Answer

Yes. D37.031 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. D37.031 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

Which HCC does D37.031 map to under V28?

Accepted Answer

D37.031 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does D37.031 pay in RAF?

Accepted Answer

D37.031 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for D37.031?

Accepted Answer

D37.031 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards D37.031 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports D37.031?

Accepted Answer

The fifth character '1' specifies sublingual glands; verify the exact salivary gland location in clinical documentation This is a more specific code than D37.09; use when the sublingual gland site is clearly documented D37.031 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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D37.031

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D37.031 ICD-10-CM Code: Neoplasm of uncertain behavior of the sublingual salivary glands

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D37.031

Is D37.031 an HCC code?

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