Q37.5

Q37.5: Cleft hard and soft palate with unilateral cleft lip

Billable / specific codeICD-10-CMPOA exempt

Q37.5 is a billable, specific ICD-10-CM code for cleft hard and soft palate with unilateral cleft lip. It is valid for submission on a claim.

Check Q37.5 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Cleft hard and soft palate with cleft lip NOS

Other codes that can never be billed with Q37.5

Their own Excludes1 notes name this code, so the conflict is not listed above.

Q35Cleft palate
Q36Cleft lip
Q38.0Congenital malformations of lips, not elsewhere classified
Q38.5Congenital malformations of palate, not elsewhere classified

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

Q37.5 is named in 7 Medicare coverage policies: 7 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A56587Billing and Coding: Cosmetic and Reconstructive Surgery
A56658Billing and Coding: Cosmetic and Reconstructive Surgery
A56868Billing and Coding: Outpatient Speech Language Pathology
A57204Billing and Coding: MRI and CT Scans of the Head and Neck

Alphabetic index entries that lead here

Cleft›lip›with cleft palate›hard›with soft
Cleft›lip›with cleft palate›soft›with hard
Cleft›palate›hard›with›soft›with cleft lip(unilateral)
Cleft›palate›soft›with›hard›with cleft lip(unilateral)

Code history

Unchanged in every release from FY2024 to FY2027.