2026 ICD-10-CM Diagnosis Code D57.04Hb-SS disease with dactylitis

ICD-10-CM Codes›D50–D89›D55-D59›D57

ICD-10-CM D57.04
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

D57.04 is a billable ICD-10-CM diagnosis code for Hb-SS disease with dactylitis. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 811 through 812. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 49 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Sickle cell trait/anemia.

For Medicare Advantage risk adjustment, D57.04 maps to CMS-HCC Category 107 (Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero) under the V28 model, adding a risk factor of about 0.457 for a community, non-dual, aged beneficiary in payment year 2026.

Code Identity

ICD-10-CM Code
D57.04
Billable Status
Yes — Valid for Submission
Code Describes
Hb-SS disease with dactylitis
Short Description
Hb-SS disease with dactylitis
Same as the full description in the CMS dataset.
Parent Code
D57.0
Hb-SS disease with crisis

Code Classification

ChapterD50–D89Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
SectionD55-D59Hemolytic anemias
CategoryD57Sickle-cell disorders
This CodeD57.04Hb-SS disease with dactylitis

Medicare Risk Adjustment (HCC)Billing

D57.04 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.

CMS-HCC V28 Category (Payment Model)
HCC 107— Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero
Payment HCC · PY 2026 one of 14 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.457
community, non-dual, aged · ranges 0.303–1.939 across segments
Hierarchy
Supersedes HCC 108
less severe related categories are not paid alongside HCC 107
Prior Model (CMS-HCC V24)
HCC 46
V24 retired V28 pays 100% of MA risk scores since PY 2026
Other CMS Models
PACE (CMS-HCC V22): HCC 46 · ESRD (V21): HCC 46 · ESRD (V24): HCC 46
ESRD V21 weights: 0.180 dialysis, 0.766–1.325 functioning graft · ESRD V24 weights: 0.223 dialysis, 0.748–4.064 functioning graft
Part D (RxHCC)
RxHCC 95 — Sickle Cell Anemia
also risk-adjusts in the Part D prescription drug model (V08)

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.

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR BLD005
Sickle cell trait/anemia
Default principal diagnosis: inpatient Yes · outpatient Yes

Code History & ChangesHistory

Replacement D57.04 replaces the following previously assigned code(s):

  • D57.09 - Hb-SS disease with crisis with other specified complication
FY 2024AddedAdded to the ICD-10-CM code setEffective October 1, 2023.
FY 2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About D57.04Overview

What is the ICD-10 code for Hb-SS disease with dactylitis?

The ICD-10-CM code for Hb-SS disease with dactylitis is D57.04 (sometimes written as D5704). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

Is D57.04 (Hb-SS disease with crisis) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report Hb-SS disease with dactylitis on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does D57.04 group to?

When Hb-SS disease with dactylitis is the principal diagnosis on an inpatient stay, it groups to MS-DRG 811, 812, with relative weights from 0.9182 to 1.4043 depending on complications. Higher weights mean higher Medicare reimbursement.

Is D57.04 a CC or MCC?

CMS lists D57.04 as an MCC (major complication or comorbidity) for FY 2026. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 49 closely related codes in its exclusion list.

What HCC is D57.04?

D57.04 (Hb-SS disease with dactylitis) maps to CMS-HCC Category 107 (Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero), commonly written as HCC 107, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 46 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 95.

Does D57.04 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, D57.04 adds a risk adjustment factor of about 0.457 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.303 to 1.939 depending on the payment segment). HCC 107 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 107 category page.