O98.613
BillableProtozoal 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 O98.613 an HCC code?
No. O98.613 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
O98.613 is the ICD-10-CM diagnosis code for protozoal diseases complicating pregnancy, third trimester. A parasitic infection (such as malaria or toxoplasmosis) that occurs during the seventh through ninth months of pregnancy. O98.613 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).
O98.613 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 accurate trimester coding and assess impact on delivery planning.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O98.613 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify accurate trimester coding and assess impact on delivery planning
- •Document any vertical transmission risk or neonatal prophylaxis considerations