2026 ICD-10-CM Diagnosis Code D57.42Sickle-cell thalassemia beta zero without crisis

ICD-10-CM Codes›D50–D89›D55-D59›D57

ICD-10-CM D57.42
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

D57.42 is a billable ICD-10-CM diagnosis code for sickle-cell thalassemia beta zero without crisis. 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. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Sickle cell trait/anemia.

For Medicare Advantage risk adjustment, D57.42 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
D57.42
Billable Status
Yes — Valid for Submission
Code Describes
Sickle-cell thalassemia beta zero without crisis
Short Description
Sickle-cell thalassemia beta zero without crisis
Same as the full description in the CMS dataset.
Parent Code
D57.4
Sickle-cell thalassemia

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 CodeD57.42Sickle-cell thalassemia beta zero without crisis

Medicare Risk Adjustment (HCC)Billing

D57.42 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.

Tabular List NotesGuidance

Coding notes and annotation back-references applicable to this code.

Inclusion Terms

  • HbS-beta zero without crisis
  • Sickle-cell beta zero without crisis

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

Patient EducationClinical

Sickle Cell Disease

Sickle cell disease (SCD) is a group of inherited red blood cell disorders. If you have SCD, there is a problem with your hemoglobin. Hemoglobin is a protein in red blood cells that carries oxygen throughout the body. With SCD, the hemoglobin forms into stiff rods within the red blood cells. This changes the shape of the red blood cells.

The full article covers:

  • What is sickle cell disease (SCD)?
  • What causes sickle cell disease (SCD)?
  • Who is more likely to have sickle cell disease (SCD)?
  • What are the symptoms of sickle cell disease (SCD)?
  • How is sickle cell disease (SCD) diagnosed?
  • What are the treatments for sickle cell disease (SCD)?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Code History & ChangesHistory

Replacement D57.42 replaces the following previously assigned code(s):

  • D57.40 - Sickle-cell thalassemia without crisis
FY 2021AddedAdded to the ICD-10-CM code setEffective October 1, 2020.
FY 2022–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About D57.42Overview

What is the ICD-10 code for sickle-cell thalassemia beta zero without crisis?

The ICD-10-CM code for sickle-cell thalassemia beta zero without crisis is D57.42 (sometimes written as D5742). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

Is D57.42 (Sickle-cell thalassemia) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report sickle-cell thalassemia beta zero without crisis on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does D57.42 group to?

When sickle-cell thalassemia beta zero without crisis 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 HCC is D57.42?

D57.42 (sickle-cell thalassemia beta zero without crisis) 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 D57.42 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, D57.42 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.