O98.513
BillableOther viral diseases complicating pregnancy, third trimester
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is O98.513 an HCC code?
No. O98.513 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
O98.513 is the ICD-10-CM diagnosis code for other viral diseases complicating pregnancy, third trimester. A viral infection other than rubella, cytomegalovirus, or hepatitis that occurs during the seventh through ninth months of pregnancy. O98.513 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering other obstetric conditions, not elsewhere classified (o94-o9a).
O98.513 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Verify trimester assignment carefully, as third trimester infections may have different management implications.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O98.513 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify trimester assignment carefully, as third trimester infections may have different management implications
- •Link this code to maternal complications or fetal effects if documented