ICD-10 D57.1
Billable / Specific HCC v28: 46Sickle-cell disease without crisis
About ICD-10-CM D57.1
ICD-10-CM code D57.1 represents Sickle-cell disease without crisis. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D57). The 2026 edition of ICD-10-CM D57.1 became effective on October 1, 2025.
Coding Tips for D57.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D57.1 is a CMS-HCC v28 risk-adjustment code (category 46). 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under D57.1. Per CMS ICD-10-CM Tabular 2026.
- Hb-SS disease without crisis
- Sickle-cell anemia NOS
- Sickle-cell disease NOS
- Sickle-cell disorder NOS
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 D57.1
Local Coverage Determinations (LCDs) from CMS MACs that list D57.1 as a covered diagnosis.
Showing top 10 of 311 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D57.1.
5 Medicare
CPT Codes Commonly Billed with D57.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 92235 CMS LCD: Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green) CMS LCD
- 92240 CMS LCD: Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green) CMS LCD
- J2791 CMS LCD: Billing and Coding: Intravenous Immunoglobulin (IVIG) CMS LCD
- J2792 CMS LCD: Billing and Coding: Intravenous Immunoglobulin (IVIG) CMS LCD
- 93895 CMS LCD: Billing and Coding: Non-Invasive Cerebrovascular Studies CMS LCD
Convert D57.1 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 |
|---|---|---|
| D57.1 | 28260 | 10000 |
| D57.1 | 28261 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D57.1
Other codes in section D55-D59 (Hemolytic anemias).
ICD-10 D57.1, Billing FAQ
Is ICD-10 code D57.1 billable? +
Yes, D57.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to D57.1? +
ICD-10 D57.1 includes: Hb-SS disease without crisis; Sickle-cell anemia NOS; Sickle-cell disease NOS, and 1 more clinical synonyms.
Does D57.1 affect Medicare Advantage HCC risk adjustment? +
Yes. D57.1 maps to CMS-HCC v28 category 46. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with D57.1? +
Procedures frequently paired with D57.1 include: 92235, 92240, J2791, J2792, 93895.
What ICD-9 codes does D57.1 map to? +
Per CMS GEMs, D57.1 maps to ICD-9 codes: 28260, 28261. 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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