ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 Q02

Billable / Specific HCC v28: 72

Microcephaly

Q02
Block
0
Synonyms
61
LCDs
5
Payer Policies
0
Linked CPTs

About ICD-10-CM Q02

ICD-10-CM code Q02 represents Microcephaly. This is a billable/specific code in the Congenital Malformations chapter (block Q02). The 2026 edition of ICD-10-CM Q02 became effective on October 1, 2025.

Coding Tips for Q02

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

HCC capture: document with MEAT each year

Q02 is a CMS-HCC v28 risk-adjustment code (category 72). 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.

Type 1 Excludes

Pure excludes, these codes can never be coded together with Q02. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • Meckel-Gruber syndrome (Q61.9)

Includes

  • hydromicrocephaly
  • micrencephalon

Coding Notes

Code First

  • , if applicable, congenital Zika virus disease

Medicare Advantage HCC Impact

CMS-HCC v28 (current)
Category 72
ESRD-HCC
Category 72
RxHCC (Part D)
Category 72

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 Q02

Local Coverage Determinations (LCDs) from CMS MACs that list Q02 as a covered diagnosis.

61 LCDs

Showing top 10 of 61 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92524 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 96112 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92521 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97130 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97129 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92597 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97110 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97533 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 96110 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92522 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing Q02.

5 policies

2 Cigna

Serum Folate and Red Blood Cell Folate Testing - (0567)
Policy ID: MM_0567
Transthoracic Echocardiography in Children - (0523)
Policy ID: MM_0523

3 Medicare

Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Policy ID: ART-54111
Billing and Coding: CT of the Head
Policy ID: ART-56612
Billing and Coding: MRI and CT Scans of the Head and Neck
Policy ID: ART-57204

CPT Codes Commonly Billed with Q02

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for Q02

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 Q02 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
Q02 7421 00000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 Q02, Billing FAQ

Is ICD-10 code Q02 billable? +

Yes, Q02 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What codes are Type 1 Excludes for Q02? +

Type 1 Excludes (never code together with Q02): Meckel-Gruber syndrome (Q61.9)

Does Q02 affect Medicare Advantage HCC risk adjustment? +

Yes. Q02 maps to CMS-HCC v28 category 72. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What ICD-9 codes does Q02 map to? +

Per CMS GEMs, Q02 maps to ICD-9 codes: 7421. 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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