ICD-10 O48.1
Billable / SpecificProlonged pregnancy
About ICD-10-CM O48.1
ICD-10-CM code O48.1 represents Prolonged pregnancy. This is a billable/specific code in the Pregnancy, Childbirth, and Puerperium chapter (block O48). The 2026 edition of ICD-10-CM O48.1 became effective on October 1, 2025.
Coding Tips for O48.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Most O codes require a 7th character indicating trimester (1 = first, 2 = second, 3 = third). Some require fetus identification character. Code O09 (supervision of high-risk pregnancy) is required as a secondary code when applicable.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under O48.1. Per CMS ICD-10-CM Tabular 2026.
- Pregnancy which has advanced beyond 42 completed weeks gestation
Medicare LCD Coverage for O48.1
Local Coverage Determinations (LCDs) from CMS MACs that list O48.1 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing O48.1.
1 Aetna
1 Cigna
CPT Codes Commonly Billed with O48.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert O48.1 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 |
|---|---|---|
| O48.1 | 64523 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To O48.1
Other codes in section O30-O48 (Maternal care related to the fetus and amniotic cavity and possible delivery problems).
ICD-10 O48.1, Billing FAQ
Is ICD-10 code O48.1 billable? +
Yes, O48.1 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 O48.1? +
ICD-10 O48.1 includes: Pregnancy which has advanced beyond 42 completed weeks gestation.
What ICD-9 codes does O48.1 map to? +
Per CMS GEMs, O48.1 maps to ICD-9 codes: 64523. 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 May 31, 2026.
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