O98.713
BillableHuman immunodeficiency virus [HIV] disease complicating pregnancy, third trimester
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is O98.713 an HCC code?
No. O98.713 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
O98.713 is the ICD-10-CM diagnosis code for human immunodeficiency virus [hiv] disease complicating pregnancy, third trimester. HIV infection in a pregnant person during the final three months of pregnancy. Close monitoring is essential during this period to prepare for delivery and prevent transmission to the newborn. O98.713 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).
O98.713 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 third trimester documentation; this code is critical for delivery planning and neonatal prophylaxis decisions.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O98.713 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify third trimester documentation; this code is critical for delivery planning and neonatal prophylaxis decisions
- •Ensure viral load status near delivery is documented for transmission risk assessment