P01.5
BillableNewborn affected by multiple pregnancy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P01.5 an HCC code?
No. P01.5 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
P01.5 is the ICD-10-CM diagnosis code for newborn affected by multiple pregnancy. A newborn from a multiple pregnancy (twins, triplets, etc.), which carries increased risks for prematurity and complications. P01.5 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering newborn affected by maternal factors and by complications of pregnancy, labor, and delivery (p00-p04).
P01.5 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.
Always specify the type of multiple pregnancy (twin, triplet, etc.) and whether it was monozygotic or dizygotic when available.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for P01.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always specify the type of multiple pregnancy (twin, triplet, etc.) and whether it was monozygotic or dizygotic when available
- •Document the birth order and any complications specific to multiple gestations such as twin-to-twin transfusion syndrome