D56.1 ICD-10-CM Code: Beta thalassemia
D56.1 maps to CMS-HCC V28 108. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) / Hemolytic anemias (D55-D59)
D56.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBeta thalassemia
A genetic blood disorder where the body cannot make enough beta-globin chains, which are part of hemoglobin. This causes moderate to severe anemia and may require regular blood transfusions.
Buddy Insight
Beta thalassemia results from mutations reducing or eliminating beta-globin chain production, causing ineffective erythropoiesis and hemolytic anemia.
CMS-HCC V28
MappedHCC 108
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 071
Code-level coefficient reference
ESRD/PACE
MappedHCC 48
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Beta thalassemia major
- Cooley's anemia
- Homozygous beta thalassemia
- Severe beta thalassemia
- Thalassemia intermedia
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for D56.1 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for D56.1 in this effective period.
Excludes 1
Official- beta thalassemia minor (D56.3)
- beta thalassemia trait (D56.3)
- delta-beta thalassemia (D56.2)
- hemoglobin E-beta thalassemia (D56.5)
- sickle-cell beta thalassemia (D57.4-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D56.1 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D56.1 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D56.1 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 D56.1 an HCC code?
Yes. D56.1 (Beta thalassemia) maps to HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.146. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: D56.1 is billable and maps to V28 HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- D56.1
- Description
- Beta thalassemia
- HCC (V28)
- HCC 108 — Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
- RAF reference coefficient
- 0.146
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work D56.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for D56.1
For D56.1 to 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 D56.1 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
D56.1 is the ICD-10-CM diagnosis code for beta thalassemia. A genetic blood disorder where the body cannot make enough beta-globin chains, which are part of hemoglobin. This causes moderate to severe anemia and may require regular blood transfusions. D56.1 sits in the ICD-10-CM chapter for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (d50-d89), within the section covering hemolytic anemias (d55-d59).
Under the CMS-HCC V28 risk adjustment model, D56.1 maps to Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major (HCC 108) with a source-labeled community, non-dual, aged reference coefficient of 0.146. No V24 mapping is shown for D56.1; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Specify the type: beta thalassemia major, intermedia, or minor based on clinical severity. Because D56.1 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for D56.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify the type: beta thalassemia major, intermedia, or minor based on clinical severity
- •Document transfusion requirements and any complications like iron overload
Clinical Significance
Beta thalassemia results from mutations reducing or eliminating beta-globin chain production, causing ineffective erythropoiesis and hemolytic anemia. Beta thalassemia major (Cooley anemia) is transfusion-dependent from early childhood, while beta thalassemia intermedia presents with moderate anemia that may or may not require transfusions. The condition carries significant morbidity from iron overload, skeletal changes, and organ damage, making it a high-acuity chronic condition.
Documentation Requirements
- ✓Documentation must specify the beta thalassemia subtype (major, intermedia, or minor), supported by hemoglobin electrophoresis, genetic testing, or molecular analysis.
- ✓Record transfusion schedule and frequency, iron chelation therapy, ferritin levels, cardiac and hepatic iron assessment results, and complications including endocrinopathies, osteoporosis, or extramedullary hematopoiesis.
- ✓Annual comprehensive assessment documentation supports recapture.
Excludes 1, Do NOT code together
Commonly Confused Codes
- •D56.1 vs. D56.0 (Alpha thalassemia) -
- •different globin chain affected. D56.1 vs. D56.5 (Hemoglobin E-beta thalassemia) -
- •D56.5 is for the specific compound heterozygous state with hemoglobin E. D56.1 vs. D57.40 (Sickle-cell thalassemia without crisis) -
- •D57.40 is for co-inheritance of sickle cell and thalassemia genes. D56.1 vs. D56.3 (Thalassemia minor) -
- •use D56.1 for beta thalassemia major and intermedia.