Q74.0
BillableOther congenital malformations of upper limb(s), including shoulder girdle
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q74.0 an HCC code?
No. Q74.0 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
Q74.0 is the ICD-10-CM diagnosis code for other congenital malformations of upper limb(s), including shoulder girdle. A congenital structural abnormality of the upper limbs or shoulder area that is not a simple reduction defect, such as abnormal bone formation or joint positioning. Q74.0 sits in the ICD-10-CM chapter for congenital malformations, deformations, chromosomal abnormalities, and genetic disorders (q00-qa0), within the section covering congenital malformations and deformations of the musculoskeletal system (q65-q79).
Q74.0 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.
This code includes malformations of the shoulder girdle, arms, and hands that are not classified as reduction defects.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q74.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code includes malformations of the shoulder girdle, arms, and hands that are not classified as reduction defects
- •Document the specific anatomical location and nature of the malformation for accurate coding