Q37.5
BillableCleft hard and soft palate with unilateral cleft lip
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q37.5 an HCC code?
No. Q37.5 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
Q37.5 is the ICD-10-CM diagnosis code for cleft hard and soft palate with unilateral cleft lip. A birth defect where both the hard and soft parts of the roof of the mouth are split on one side, with a cleft on one side of the upper lip. Q37.5 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).
Q37.5 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.
Ensure documentation confirms both hard and soft palate involvement with unilateral cleft lip.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q37.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.