2026 ICD-10-CM Diagnosis Code D56.5Hemoglobin E-beta thalassemia
ICD-10-CM Codes›D50–D89›D55-D59›D56
- Billable — Valid for Submission
- Risk Adjusts — HCC 108
- Chronic Condition
D56.5 is a billable ICD-10-CM diagnosis code for hemoglobin E-beta thalassemia. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 791, 793, 811 through 812. Coders also document this condition as hemoglobin E beta plus thalassemia. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Hemolytic anemia.
For Medicare Advantage risk adjustment, D56.5 maps to CMS-HCC Category 108 (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major) under the V28 model, adding a risk factor of about 0.146 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
D56.5 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Hemoglobin E beta plus thalassemia
- Hemoglobin E beta zero thalassemia
- Hemoglobin E disease
- Hemoglobin E/beta thalassemia disease
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Type 1 Excludes
- beta thalassemia D56.1
- beta thalassemia minor D56.3
- beta thalassemia trait D56.3
- delta-beta thalassemia D56.2
- delta-beta thalassemia trait D56.3
- hemoglobin E disease D58.2
- other hemoglobinopathies D58.2
- sickle-cell beta thalassemia D57.4
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Disease, diseased See Also: Syndrome;
Hemoglobin See Also: condition;
E-beta thalassemia D56.5
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Hemoglobin E Disease
a condition characterized by the presence of a variant of normal hemoglobin (hemoglobin e), which is caused by mutation(s) in the gene encoding the beta subunit of the hemoglobin molecule.Sickle Cell-Hemoglobin E Disease|Hemoglobin SE Disease
a variant of sickle cell disease due to heterozygosity for hemoglobin s and hemoglobin e mutations. patients present with the symptoms of sickle cell disease but the symptoms are less frequent and severe compared to patients with hemoglobin ss disease.
Patient EducationClinical
Thalassemia
Thalassemias are inherited blood disorders. If you have one, your body makes fewer healthy red blood cells and less hemoglobin. Hemoglobin is a protein that carries oxygen to the body. That leads to anemia. Thalassemias occur most often among people of Italian, Greek, Middle Eastern, Southern Asian, and African descent.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert D56.5 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About D56.5Overview
What is the ICD-10 code for hemoglobin E-beta thalassemia?
The ICD-10-CM code for hemoglobin E-beta thalassemia is D56.5 (sometimes written as D565). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is D56.5 (Thalassemia) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report hemoglobin E-beta thalassemia on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does D56.5 group to?
When hemoglobin E-beta thalassemia is the principal diagnosis on an inpatient stay, it groups to MS-DRG 791, 793, 811, 812, with relative weights from 0.9182 to 4.1696 depending on complications. Higher weights mean higher Medicare reimbursement.
What is the ICD-9 equivalent of D56.5?
Under the General Equivalence Mappings, hemoglobin E-beta thalassemia converts to ICD-9-CM 282.47 (hgb E-beta thalassemia). The mapping is a direct match.
What HCC is D56.5?
D56.5 (hemoglobin E-beta thalassemia) maps to CMS-HCC Category 108 (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major), commonly written as HCC 108, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 48 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does D56.5 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, D56.5 adds a risk adjustment factor of about 0.146 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.098 to 0.416 depending on the payment segment). A more severe related category (HCC 107) supersedes it when both are reported. See the full factor table on the HCC 108 category page.
