D57.1
BillableSickle-cell disease without crisis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.1 an HCC code?
Yes. D57.1 maps to Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero under the CMS-HCC V28 risk adjustment model (and Severe Hematological Disorders under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for D57.1
For D57.1 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 D57.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.1 is the ICD-10-CM diagnosis code for sickle-cell disease without crisis. Sickle cell disease in its most severe form without an acute crisis episode, meaning the patient is in a stable state with chronic anemia but no acute complications. D57.1 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, D57.1 maps to Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero (HCC 107) with a community, non-dual, aged base RAF weight of 0.727. Under the older CMS-HCC V24 model, D57.1 maps to Severe Hematological Disorders (HCC 46) with a community, non-dual, aged base RAF weight of 0.666. 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.
Use only when no acute crisis is present; if any crisis develops, use D57.00-D57.09 instead. Because D57.1 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for D57.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Sickle cell disease without crisis represents the chronic baseline state of Hemoglobin SS disease when the patient is not experiencing an acute vaso-occlusive or hemolytic crisis. Even in steady state, patients have chronic hemolytic anemia, elevated baseline pain levels, and ongoing organ damage from repeated sickling episodes. This code captures the chronic disease burden that persists between acute crises, including chronic pain management, disease-modifying therapy (hydroxyurea), and surveillance for silent organ damage.
Documentation Requirements
- ✓Document the Hemoglobin SS genotype, confirm the patient is not in acute crisis at the encounter, and record baseline hemoglobin, reticulocyte count, and lactate dehydrogenase.
- ✓Document current medications including hydroxyurea dosing and compliance, chronic transfusion protocol if applicable, vaccination status (particularly pneumococcal), screening results for pulmonary hypertension, renal function, and retinopathy.
- ✓Record pain management regimen for chronic sickle cell pain.