Q06.1
BillableHypoplasia and dysplasia of spinal cord
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q06.1 an HCC code?
Yes. Q06.1 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 Q06.1
For Q06.1 to 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 Q06.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Q06.1 is the ICD-10-CM diagnosis code for hypoplasia and dysplasia of spinal cord. A birth defect where the spinal cord is underdeveloped or abnormally formed, resulting in reduced size or improper structure. Q06.1 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, Q06.1 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, Q06.1 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.
Document whether condition is hypoplasia (underdevelopment) or dysplasia (abnormal development). Because Q06.1 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 Q06.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether condition is hypoplasia (underdevelopment) or dysplasia (abnormal development)
- •Specify anatomical level affected if documented
Clinical Significance
Hypoplasia and dysplasia of the spinal cord represents underdevelopment or abnormal formation of spinal cord tissue, leading to variable degrees of neurological dysfunction. This condition requires ongoing monitoring for progressive neurological changes and comprehensive rehabilitation to optimize functional outcomes.
Documentation Requirements
- ✓Imaging studies confirming spinal cord underdevelopment
- ✓Detailed neurological examination and deficit documentation
- ✓Functional assessment including motor and sensory testing
- ✓Associated malformations or complications
- ✓Developmental milestone assessments
- ✓Therapy and rehabilitation needs
- ✓Monitoring for tethered cord syndrome
- ✓Multidisciplinary care coordination documentation