Q06.0
BillableAmyelia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q06.0 an HCC code?
Yes. Q06.0 maps to Spinal Cord Disorders/Injuries under the CMS-HCC V28 risk adjustment model (and Spinal Cord Disorders/Injuries under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for Q06.0
For Q06.0to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed Q06.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Q06.0 is the ICD-10-CM diagnosis code for amyelia. A rare birth defect where the spinal cord is completely absent or fails to develop. Q06.0 sits in the ICD-10-CM chapter for congenital malformations, deformations, chromosomal abnormalities, and genetic disorders (q00-qa0), within the section covering congenital malformations of the nervous system (q00-q07).
Under the CMS-HCC V28 risk adjustment model, Q06.0 maps to Spinal Cord Disorders/Injuries (HCC 182) with a community, non-dual, aged base RAF weight of 0.282. Under the older V24 model, Q06.0 mapped to the same category but with a base RAF weight of 0.464 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This is a severe condition - ensure documentation clearly indicates complete absence of spinal cord tissue. Because Q06.0 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q06.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a severe condition - ensure documentation clearly indicates complete absence of spinal cord tissue
- •Verify this is not confused with severe hypoplasia (underdevelopment) coded as Q06.1
Clinical Significance
Amyelia represents a severe and rare congenital anomaly where the spinal cord is completely absent, typically incompatible with life or associated with extremely poor prognosis. When documented, this condition indicates profound neurological compromise requiring intensive supportive care and palliative management.
Documentation Requirements
- ✓Radiological confirmation of absent spinal cord
- ✓Detailed neurological examination findings
- ✓Associated congenital anomalies documentation
- ✓Functional assessment and prognosis
- ✓Multidisciplinary care team involvement
- ✓Family counseling and support documentation
- ✓Palliative care considerations if appropriate
- ✓Genetic counseling referrals