P05.12 ICD-10-CM Code: Newborn small for gestational age, 500-749 grams
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FY 2026 Apr update / Certain conditions originating in the perinatal period (P00-P96) / Disorders of newborn related to length of gestation and fetal growth (P05-P08)
P05.12
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNewborn small for gestational age, 500-749 grams
A newborn baby who is smaller than expected for their gestational age, weighing between 500-749 grams at birth.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Newborn small-and-light-for-dates
- Newborn small-for-dates
- Weight and length below 10th percentile for gestational age
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for P05.12 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for P05.12 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for P05.12 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for P05.12 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for P05.12 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for P05.12 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is P05.12 an HCC code?
No. P05.12 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
P05.12 is the ICD-10-CM diagnosis code for newborn small for gestational age, 500-749 grams. A newborn baby who is smaller than expected for their gestational age, weighing between 500-749 grams at birth. P05.12 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).
P05.12 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 category requires careful documentation of all interventions and complications.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for P05.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.