Z36.1
BillableEncounter for antenatal screening for raised alphafetoprotein level
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z36.1 an HCC code?
No. Z36.1 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
Z36.1 is the ICD-10-CM diagnosis code for encounter for antenatal screening for raised alphafetoprotein level. A prenatal screening test that measures elevated levels of alphafetoprotein (AFP) in maternal blood, which may indicate fetal abnormalities. Z36.1 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons encountering health services in circumstances related to reproduction (z30-z39).
Z36.1 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.
AFP elevation can indicate neural tube defects, Down syndrome, or other conditions requiring follow-up.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z36.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •AFP elevation can indicate neural tube defects, Down syndrome, or other conditions requiring follow-up
- •Document whether this is part of a triple or quad screen panel