ICD-10 D56.4
Billable / Specific HCC v28: 48Hereditary persistence of fetal hemoglobin [HPFH]
About ICD-10-CM D56.4
ICD-10-CM code D56.4 represents Hereditary persistence of fetal hemoglobin [HPFH]. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D56). The 2026 edition of ICD-10-CM D56.4 became effective on October 1, 2025.
Coding Tips for D56.4
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D56.4 is a CMS-HCC v28 risk-adjustment code (category 48). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for D56.4
Local Coverage Determinations (LCDs) from CMS MACs that list D56.4 as a covered diagnosis.
Showing top 10 of 54 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D56.4.
4 Medicare
1 Aetna
Convert D56.4 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| D56.4 | 2827 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D56.4
Other codes in section D55-D59 (Hemolytic anemias).
ICD-10 D56.4, Billing FAQ
Is ICD-10 code D56.4 billable? +
Yes, D56.4 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does D56.4 affect Medicare Advantage HCC risk adjustment? +
Yes. D56.4 maps to CMS-HCC v28 category 48. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with D56.4? +
Procedures frequently paired with D56.4 include: J2791, J2792.
What ICD-9 codes does D56.4 map to? +
Per CMS GEMs, D56.4 maps to ICD-9 codes: 2827. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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