D56.9 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupD56.9

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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)

D56.9

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Thalassemia, unspecified

A hereditary blood disorder affecting red blood cell production and hemoglobin function, but the specific type of thalassemia is not specified in the medical record.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

D56Thalassemia D56.9Thalassemia, unspecified

Inclusion Terms

Official

Mediterranean anemia (with other hemoglobinopathy)

Excludes 2

Official

autoimmune disease (systemic) NOS (M35.9)Inherited from D50-D89
certain conditions originating in the perinatal period (P00-P96)Inherited from D50-D89
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from D50-D89
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from D50-D89
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from D50-D89
human immunodeficiency virus [HIV] disease (B20)Inherited from D50-D89
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from D50-D89
neoplasms (C00-D49)Inherited from D50-D89
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from D50-D89

Related Codes

Official

D56.0Alpha thalassemia D56.1Beta thalassemia D56.2Delta-beta thalassemia D56.3Thalassemia minor D56.4Hereditary persistence of fetal hemoglobin [HPFH]

Includes

Official

No Includes notes are included in this display for D56.9. Check the code and parent instructions in the Code Book.

Excludes 1

Official

sickle-cell thalassemia (D57.4-)Inherited from D56

Code First

Official

No Code First sequencing instructions are included in this display for D56.9. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for D56.9. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for D56.9. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

This is a default code; query the provider if more specific thalassemia type information is available in the chart

Review lab results and clinical presentation to determine if a more specific D56 code applies

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 D56.9 an HCC code?

No. D56.9 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: D56.9
Description: Thalassemia, unspecified
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

D56.9 is the ICD-10-CM diagnosis code for thalassemia, unspecified. A hereditary blood disorder affecting red blood cell production and hemoglobin function, but the specific type of thalassemia is not specified in the medical record. D56.9 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).

D56.9 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, 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.

This is a default code; query the provider if more specific thalassemia type information is available in the chart.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for D56.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is a default code; query the provider if more specific thalassemia type information is available in the chart
•Review lab results and clinical presentation to determine if a more specific D56 code applies