Q38.5 ICD-10-CM Code: Congenital malformations of palate, not elsewhere classified
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FY 2026 Apr update / Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0) / Other congenital malformations of the digestive system (Q38-Q45)
Q38.5
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCongenital malformations of palate, not elsewhere classified
A birth defect of the roof of the mouth (palate) that is not classified elsewhere, such as cleft palate or other structural abnormalities.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Congenital absence of uvula
- Congenital malformation of palate NOS
- Congenital high arched palate
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Q38.5 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Q38.5 in this effective period.
Excludes 1
Official- cleft palate (Q35.-)
- cleft palate with cleft lip (Q37.-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Q38.5 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Q38.5 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Q38.5 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is Q38.5 an HCC code?
No. Q38.5 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
Q38.5 is the ICD-10-CM diagnosis code for congenital malformations of palate, not elsewhere classified. A birth defect of the roof of the mouth (palate) that is not classified elsewhere, such as cleft palate or other structural abnormalities. Q38.5 sits in the ICD-10-CM chapter for congenital malformations, deformations and chromosomal abnormalities (q00-qa0), within the section covering other congenital malformations of the digestive system (q38-q45).
Q38.5 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.
Use this code only when the palate defect doesn't fit into more specific categories.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q38.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.