D57.40
BillableSickle-cell thalassemia without crisis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.40 an HCC code?
Yes. D57.40 maps to Sickle Cell Disorders and Thalassemia 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 D57.40
For D57.40 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 D57.40 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.40 is the ICD-10-CM diagnosis code for sickle-cell thalassemia without crisis. A blood disorder combining sickle cell disease with thalassemia (another inherited blood condition) without an acute crisis episode. D57.40 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, D57.40 maps to Sickle Cell Disorders and Thalassemia (HCC 108) with a community, non-dual, aged base RAF weight of 0.607. Under the older CMS-HCC V24 model, D57.40 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.
This code is for stable disease without acute complications; if a crisis occurs, use a more specific code from D57.41x series. Because D57.40 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 D57.40 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is for stable disease without acute complications; if a crisis occurs, use a more specific code from D57.41x series
- •Document whether the patient is in steady state or experiencing complications to ensure correct code selection
Clinical Significance
Sickle-cell thalassemia without crisis represents the chronic baseline state of a compound heterozygous condition combining a sickle hemoglobin gene with a thalassemia gene. Clinical severity depends on whether the thalassemia component is beta-zero (no beta-globin production) or beta-plus (reduced beta-globin production). This unspecified code is used when the beta-zero vs. beta-plus distinction is not documented. Patients require ongoing monitoring for organ damage, pain management, and disease-modifying therapy.
Documentation Requirements
- ✓Document the sickle-cell thalassemia genotype confirmed by hemoglobin electrophoresis or genetic testing, and specify the thalassemia component as beta-zero or beta-plus when known.
- ✓Record baseline hemoglobin, reticulocyte count, current medications (hydroxyurea, folic acid), transfusion history, and screening for complications including retinopathy, avascular necrosis, renal dysfunction, and pulmonary hypertension.
- ✓Confirm no active crisis at the encounter.