2026 ICD-10-CM Diagnosis Code P36.0Sepsis of newborn due to streptococcus, group B
ICD-10-CM Codes›P00–P96›P35-P39›P36
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 2
- Not Chronic
P36.0 is a billable ICD-10-CM diagnosis code for sepsis of newborn due to streptococcus, group B. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 791, 793. 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 48 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Bacterial infections, Perinatal infections, and Septicemia.
For Medicare Advantage risk adjustment, P36.0 maps to CMS-HCC Category 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock) under the V28 model, adding a risk factor of about 0.500 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
P36.0 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.
- Bacterial sepsis of newborn
- Early-onset neonatal sepsis
- Neonatal sepsis caused by Streptococcus
- Perinatal sepsis
- Perinatal sepsis caused by Streptococcus agalactiae
- Sepsis caused by Streptococcus agalactiae
- Sepsis of newborn caused by group B Streptococcus
- Sepsis of newborn due to Streptococcus agalactiae
- Septic shock co-occurrent with acute organ dysfunction caused by Streptococcus
- Septic shock co-occurrent with acute organ dysfunction due to Gram-positive coccus
- Septic shock co-occurrent with acute organ dysfunction due to Group B streptococcus
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.
Patient EducationClinical
Sepsis
Sepsis is your body's overactive and extreme response to an infection. Sepsis is a life-threatening medical emergency. Without quick treatment, it can lead to tissue damage, organ failure, and even death.
The full article covers:
- What is sepsis?
- What causes sepsis?
- Who is more likely to develop sepsis?
- What are the symptoms of sepsis?
- What other problems can sepsis cause?
- How is sepsis diagnosed?
- What are the treatments for sepsis?
- Can sepsis be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert P36.0 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About P36.0Overview
What is the ICD-10 code for sepsis of newborn due to streptococcus, group B?
The ICD-10-CM code for sepsis of newborn due to streptococcus, group B is P36.0 (sometimes written as P360). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is P36.0 (Bacterial sepsis of newborn) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report sepsis of newborn due to streptococcus, group B on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does P36.0 group to?
When sepsis of newborn due to streptococcus, group B is the principal diagnosis on an inpatient stay, it groups to MS-DRG 791, 793, with relative weights from 4.0590 to 4.1696 depending on complications. Higher weights mean higher Medicare reimbursement.
Is P36.0 a CC or MCC?
CMS lists P36.0 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 48 closely related codes in its exclusion list.
What is the ICD-9 equivalent of P36.0?
Under the General Equivalence Mappings, sepsis of newborn due to streptococcus, group B converts to ICD-9-CM 771.81 (NB septicemia [sepsis]). The mapping is approximate, so confirm the match fits the documentation.
What HCC is P36.0?
P36.0 (sepsis of newborn due to streptococcus, group B) maps to CMS-HCC Category 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock), commonly written as HCC 2, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 2 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 P36.0 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, P36.0 adds a risk adjustment factor of about 0.500 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.447 to 0.780 depending on the payment segment). HCC 2 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 2 category page.
