2027 ICD-10-CM Diagnosis Code P96.1Neonatal withdrawal symptoms from maternal use of drugs of addiction
ICD-10-CM Codes›P00–P96›P90-P96›P96
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 137
- Not Chronic
P96.1 is a billable ICD-10-CM diagnosis code for neonatal withdrawal symptoms from maternal use of drugs of addiction. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 791, 793. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 4 closely related codes. Coders also document this condition as neonatal abstinence syndrome. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Neonatal abstinence syndrome and Newborn affected by maternal conditions or complications of labor/delivery.
For Medicare Advantage risk adjustment, P96.1 maps to CMS-HCC Category 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) under the V28 model, adding a risk factor of about 0.424 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
P96.1 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 2027.
Source: CMS Payment Year 2027 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.
- Neonatal abstinence syndrome
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to P96.1: its own notes plus those printed at Chapter 16. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- conditions that have their origin in the fetal or perinatal period (before birth through the first 28 days after birth) even if morbidity occurs later
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Drug withdrawal syndrome in infant of dependent mother
- Neonatal abstinence syndrome
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- reactions and intoxications from maternal opiates and tranquilizers administered during labor and delivery (P04.0)
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Notes
General instructions on how these codes are used.
- Codes from this chapter are for use on newborn records only, never on maternal records
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name P96.1, its category, or a range that includes it.
Excludes1 1
These codes carry an Excludes1 note naming P96.1: they are not reported together with it, unless the two conditions are unrelated.
- P93 Reactions and intoxications due to drugs administered to newbornwithdrawal symptoms from maternal use of drugs of addiction (P96.1)
Excludes2 1
These codes carry an Excludes2 note naming P96.1: its condition is not part of those codes, and both may be reported when the patient has both.
- P04.49 Newborn affected by maternal use of other drugs of addictionwithdrawal symptoms from maternal use of drugs of addiction (P96.1)
Code First 1
These codes say to code first a condition named in the note, and P96.1 is one of the conditions named.
- P04.1 Newborn affected by other maternal medicationif applicable, withdrawal symptoms from maternal use of drugs of addiction (P96.1)
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Reaction See Also: Disorder;
withdrawal See: Dependence, by drug, with, withdrawal;
newborn P96.1
Syndrome See Also: Disease;
abstinence, neonatal P96.1
neonatal abstinence P96.1
withdrawal See: Withdrawal, state;
Withdrawal state See Also: Dependence, drug by type, with withdrawal;
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Pregnancy and Substance Use
During pregnancy, there are many things you can do to keep yourself and your baby healthy. They include getting regular prenatal care, eating healthy, and staying active. But it's also very important to avoid substances that could be harmful to you and your baby, such as tobacco, alcohol, and drugs.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert P96.1 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About P96.1Overview
What is the ICD-10 code for neonatal withdrawal symptoms from maternal use of drugs of addiction?
The ICD-10-CM code for neonatal withdrawal symptoms from maternal use of drugs of addiction is P96.1 (sometimes written as P961). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is P96.1 (Other conditions originating in the perinatal period) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report neonatal withdrawal symptoms from maternal use of drugs of addiction on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does P96.1 group to?
When neonatal withdrawal symptoms from maternal use of drugs of addiction is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, with relative weights from 4.1073 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is P96.1 a CC or MCC?
CMS lists P96.1 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 4 closely related codes in its exclusion list.
Can P96.1 be reported with P04.0?
Not as a rule. The Excludes1 note on P96.1 lists "reactions and intoxications from maternal opiates and tranquilizers administered during labor and delivery (P04.0)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is P96.1?
P96.1 (neonatal withdrawal symptoms from maternal use of drugs of addiction) maps to CMS-HCC Category 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications), commonly written as HCC 137, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It does not map to any RxHCC in the Part D prescription drug model.
Does P96.1 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, P96.1 adds a risk adjustment factor of about 0.424 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.297 to 0.502 depending on the payment segment). A more severe related category (HCC 135 and HCC 136) supersedes it when both are reported. See the full factor table on the HCC 137 category page.
