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Q87.11

Q87.11: Prader-Willi syndrome

Billable / specific codeICD-10-CMPOA exempt

Q87.11 is a billable, specific ICD-10-CM code for prader-willi syndrome. It is valid for submission on a claim.

Check Q87.11 with the rest of the claim: free scrubber

Excludes1 inherited from the categories above Q87.11

A category’s note binds every code beneath it.

Written on Q87.1: Congenital malformation syndromes predominantly associated with short stature

  • Ellis-van Creveld syndrome (Q77.6)
  • Smith-Lemli-Opitz syndrome (E78.72)

Other codes that can never be billed with Q87.11

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

  • E23.3Hypothalamic dysfunction, not elsewhere classified
  • Q67Congenital musculoskeletal deformities of head, face, spine and chest
  • Q75Other congenital malformations of skull and face bones
  • Q89.7Multiple congenital malformations, not elsewhere classified

Risk adjustment

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

Medicare coverage

Q87.11 is named in 3 Medicare coverage policies: 3 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

  • A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
  • A56726Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
  • A57071Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

Alphabetic index entries that lead here

  • Prader-Willi syndrome
  • Syndrome›Prader-Willi

Code history

Unchanged in every release from FY2024 to FY2027.

Other codes under Q87.1

ICD-10-CMFY2027· effective October 1, 2026

Loaded directly from the CMS/NCHS ICD-10-CM public-domain release: see data sources and our editorial policy. If this page disagrees with the CMS tabular list, this page is wrong. Reference information for professional coders; not medical or billing advice.