Q16.0
BillableCongenital absence of (ear) auricle
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q16.0 an HCC code?
No. Q16.0 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
Q16.0 is the ICD-10-CM diagnosis code for congenital absence of (ear) auricle. A birth defect where the external ear (auricle) is completely absent or underdeveloped from birth. Q16.0 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 eye, ear, face and neck (q10-q18).
Q16.0 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.
Document whether the absence is unilateral or bilateral, as this affects severity and treatment planning.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q16.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether the absence is unilateral or bilateral, as this affects severity and treatment planning
- •This code may be used with hearing impairment codes if the malformation affects hearing function