Q05.4
Q05.4: Unspecified spina bifida with hydrocephalus
Billable / specific codeICD-10-CMPOA exempt
Q05.4 is a billable, specific ICD-10-CM code for unspecified spina bifida with hydrocephalus. It is valid for submission on a claim.
Check Q05.4 with the rest of the claim: free scrubberOther codes that can never be billed with Q05.4
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
Q05.4 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 182 Spinal Cord Disorders/Injuries0.478 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
Q05.4 is named in 6 Medicare coverage policies: 6 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
- A56722Billing and Coding: Intraoperative Neurophysiological Testing
- A57041Billing and Coding: Somatosensory Testing
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
Alphabetic index entries that lead here
- Spina bifida›with hydrocephalus NEC
- Hydrocephalus›congenital›with spina bifida
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under Q05
- Q05.0Cervical spina bifida with hydrocephalus
- Q05.1Thoracic spina bifida with hydrocephalus
- Q05.2Lumbar spina bifida with hydrocephalus
- Q05.3Sacral spina bifida with hydrocephalus
- Q05.5Cervical spina bifida without hydrocephalus
- Q05.6Thoracic spina bifida without hydrocephalus
- Q05.7Lumbar spina bifida without hydrocephalus
- Q05.8Sacral spina bifida without hydrocephalus
- Q05.9Spina bifida, unspecified