P05.11
BillableNewborn small for gestational age, less than 500 grams
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P05.11 an HCC code?
No. P05.11 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
P05.11 is the ICD-10-CM diagnosis code for newborn small for gestational age, less than 500 grams. A newborn baby who is smaller than expected for their gestational age, weighing less than 500 grams at birth. P05.11 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering disorders of newborn related to length of gestation and fetal growth (p05-p08).
P05.11 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.
This extremely low birth weight indicates a critically ill newborn requiring intensive neonatal care.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for P05.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This extremely low birth weight indicates a critically ill newborn requiring intensive neonatal care
- •Verify all documentation carefully as these cases often involve multiple complications and comorbidities