C09.9: Malignant neoplasm of tonsil, unspecified
C09.9, malignant neoplasm of tonsil, unspecified, is listed as a covered diagnosis in 6 Medicare billing and coding articles that apply to 38 HCPCS Level II codes, including G0340 (Image-guided robotic linear accelerator-based stereotactic…), G0339 (Image-guided robotic linear accelerator-based stereotactic…), G0563 (Stereotactic body radiation therapy, treatment delivery…). 4 of these codes have a 2026 DMEPOS fee schedule amount; E0783 pays $9,917.33 to $11,667.45 (NU) depending on the state. The articles come from 3 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with C09.9 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G0340 | Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment | Carrier judgment | — | 2 |
| G0339 | Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment | Carrier judgment | — | 2 |
| G0563 | Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions | Carrier judgment | — | 1 |
| J9267 | Injection, paclitaxel, 1 mg | Special coverage instructions apply | — | 1 |
| J9264 | Injection, paclitaxel protein-bound particles, 1 mg | Carrier judgment | — | 1 |
| J8999 | Prescription drug, oral, chemotherapeutic, nos | Special coverage instructions apply | — | 1 |
| Q0512 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period | Special coverage instructions apply | — | 1 |
| Q0511 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period | Special coverage instructions apply | — | 1 |
| J8530 | Cyclophosphamide; oral, 25 mg | Special coverage instructions apply | — | 1 |
| J8597 | Antiemetic drug, oral, not otherwise specified | Special coverage instructions apply | — | 1 |
| J8610 | Methotrexate; oral, 2.5 mg | Special coverage instructions apply | — | 1 |
| J8498 | Antiemetic drug, rectal/suppository, not otherwise specified | Special coverage instructions apply | — | 1 |
| Q5110 | Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram | Special coverage instructions apply | — | 1 |
| Q5125 | Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram | Carrier judgment | — | 1 |
| Q5101 | Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram | Special coverage instructions apply | — | 1 |
| J1442 | Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram | Special coverage instructions apply | — | 1 |
| J1449 | Injection, eflapegrastim-xnst, 0.1 mg | Carrier judgment | — | 1 |
| J1447 | Injection, tbo-filgrastim, 1 microgram | Special coverage instructions apply | — | 1 |
| Q5108 | Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| Q5111 | Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| Q5127 | Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| Q5122 | Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| Q5130 | Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| J2820 | Injection, sargramostim (gm-csf), 50 mcg | Special coverage instructions apply | — | 1 |
13 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing C09.9
- A56874: Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) (Wellpoint Federal (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L35076
- A52450: Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) (Wellpoint Federal (MAC - Part A, MAC - Part B); 2 Level II codes)
- A59350: Billing and Coding: Radiation Therapies (Palmetto GBA (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L39553
- A52479: Oral Anticancer Drugs - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 8 Level II codes). LCD with the same title: L33826
- A56748: Billing and Coding: White Cell Colony Stimulating Factors (Palmetto GBA (MAC - Part A, MAC - Part B); 16 Level II codes). LCD with the same title: L37176
- A56695: Billing and Coding: Implantable Infusion Pump (Palmetto GBA (MAC - Part B); 9 Level II codes). LCD with the same title: L33461
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other C09 diagnoses (Malignant neoplasm of tonsil)
- C09.0 — Malignant neoplasm of tonsillar fossa
- C09.1 — Malignant neoplasm of tonsillar pillar (anterior) (posterior)
- C09.8 — Malignant neoplasm of overlapping sites of tonsil
Frequently asked questions
Does Medicare cover C09.9 (Malignant neoplasm of tonsil, unspecified)?
Medicare covers items and services, not diagnoses. 6 Medicare billing and coding articles list C09.9 as a covered diagnosis for 38 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 C09.9?
The Level II codes from the policies most specific to this diagnosis are G0340 (Image-guided robotic linear accelerator-based stereotactic…, 2 articles); G0339 (Image-guided robotic linear accelerator-based stereotactic…, 2 articles); G0563 (Stereotactic body radiation therapy, treatment delivery…, 1 article); J9267 (Injection, paclitaxel, 1 mg, 1 article); J9264 (Injection, paclitaxel protein-bound particles, 1 mg, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with C09.9?
Under the 2026 DMEPOS fee schedule (non-rural state fees): E0783 $9,917.33 to $11,667.45 (NU); E0786 $10,969.75 to $11,380.88 (NU); E0782 $5,200.92 to $6,118.73 (NU); E0785 $572.38 to $673.39 (KF). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list C09.9?
A56874 (Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)); A52450 (Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)); A59350 (Billing and Coding: Radiation Therapies), and 3 more articles.
What is ICD-10-CM code C09.9?
C09.9 is the ICD-10-CM code for malignant neoplasm of tonsil, unspecified, in category C09 (Malignant neoplasm of tonsil), chapter 2: Neoplasms.
Next steps
- Run a reimbursement report for a device billed under G0340
- Watch G0340 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0340
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.