D37.05 ICD-10-CM Code: Neoplasm of uncertain behavior of pharynx
D37.05 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Neoplasms (C00-D49) / Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48)
D37.05
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNeoplasm of uncertain behavior of pharynx
This code describes an abnormal growth in the pharynx (throat) that cannot yet be determined to be cancer or benign. The growth requires further testing or monitoring to establish its true nature.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Neoplasm of uncertain behavior of aryepiglottic fold of pharynx NOS
- Neoplasm of uncertain behavior of hypopharyngeal aspect of aryepiglottic fold of pharynx
- Neoplasm of uncertain behavior of marginal zone of aryepiglottic fold of pharynx
Excludes 2
OfficialNo Excludes 2 notes are included in this display for D37.05. Check the code and parent instructions in the Code Book.
Related Codes
Includes
OfficialNo Includes notes are included in this display for D37.05. Check the code and parent instructions in the Code Book.
Excludes 1
Official- neoplasms of unspecified behavior (D49.-)Inherited from D37-D48, D37, D37.0
- stromal tumors of uncertain behavior of digestive system (D48.1-)Inherited from D37-D48, D37, D37.0
- neoplasm of uncertain behavior of aryepiglottic fold or interarytenoid fold, laryngeal aspect (D38.0)Inherited from D37-D48, D37, D37.0
- neoplasm of uncertain behavior of epiglottis NOS (D38.0)Inherited from D37-D48, D37, D37.0
- neoplasm of uncertain behavior of skin of lip (D48.5)Inherited from D37-D48, D37, D37.0
- neoplasm of uncertain behavior of suprahyoid portion of epiglottis (D38.0)Inherited from D37-D48, D37, D37.0
Code First
OfficialNo Code First sequencing instructions are included in this display for D37.05. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for D37.05. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for D37.05. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is D37.05 an HCC code?
No. D37.05 is a billable ICD-10-CM code with no mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models.
- Code
- D37.05
- Description
- Neoplasm of uncertain behavior of pharynx
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- 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
D37.05 is the ICD-10-CM diagnosis code for neoplasm of uncertain behavior of pharynx. This code describes an abnormal growth in the pharynx (throat) that cannot yet be determined to be cancer or benign. The growth requires further testing or monitoring to establish its true nature. D37.05 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).
D37.05 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.
Ensure documentation specifies the location within the pharynx (nasopharynx, oropharynx, laryngopharynx) if available, as this may affect treatment planning.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for D37.05 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation specifies the location within the pharynx (nasopharynx, oropharynx, laryngopharynx) if available, as this may affect treatment planning
- •Do not use this code if the neoplasm has been definitively diagnosed as malignant (C-codes) or benign (D10-D36 codes); this code is specifically for uncertain behavior lesions pending further evaluation