Q35.5
BillableCleft hard palate with cleft soft palate
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q35.5 an HCC code?
No. Q35.5 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
Q35.5 is the ICD-10-CM diagnosis code for cleft hard palate with cleft soft palate. A birth defect where both the hard palate (bony roof) and soft palate (muscular back portion) are cleft, representing a more extensive palatal split. Q35.5 sits in the ICD-10-CM chapter for congenital malformations, deformations, chromosomal abnormalities, and genetic disorders (q00-qa0), within the section covering cleft lip and cleft palate (q35-q37).
Q35.5 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 code indicates involvement of both palatal structures; do not use with separate codes for hard or soft palate alone.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q35.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates involvement of both palatal structures; do not use with separate codes for hard or soft palate alone
- •Document the extent of the cleft and any associated complications for surgical planning