P96.3
BillableWide cranial sutures of newborn
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P96.3 an HCC code?
No. P96.3 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
P96.3 is the ICD-10-CM diagnosis code for wide cranial sutures of newborn. A newborn has abnormally wide spaces between the bones of the skull, which typically close as the infant grows. P96.3 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering other disorders originating in the perinatal period (p90-p96).
P96.3 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 is often a normal variant in newborns and may resolve spontaneously; document whether imaging was performed.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for P96.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is often a normal variant in newborns and may resolve spontaneously; document whether imaging was performed
- •Differentiate from pathological causes of wide sutures such as hydrocephalus or increased intracranial pressure