O98.611
BillableProtozoal diseases complicating pregnancy, first trimester
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is O98.611 an HCC code?
No. O98.611 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
O98.611 is the ICD-10-CM diagnosis code for protozoal diseases complicating pregnancy, first trimester. A parasitic infection (such as malaria or toxoplasmosis) that occurs during the first three months of pregnancy. O98.611 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).
O98.611 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.
Identify the specific protozoal disease and assign an additional code if available for specificity.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O98.611 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Identify the specific protozoal disease and assign an additional code if available for specificity
- •Document any fetal effects or maternal complications related to the parasitic infection