2026 ICD-10-CM Diagnosis Code P96.2Withdrawal symptoms from therapeutic use of drugs in newborn
ICD-10-CM Codes›P00–P96›P90-P96›P96
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 137
- Not Chronic
P96.2 is a billable ICD-10-CM diagnosis code for withdrawal symptoms from therapeutic use of drugs in newborn. 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 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 withdrawal symptom. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Neonatal abstinence syndrome.
For Medicare Advantage risk adjustment, P96.2 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 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
P96.2 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.
- Withdrawal symptom
- Withdrawal symptoms from therapeutic use of drugs in newborn
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Syndrome See Also: Disease;
withdrawal See: Withdrawal, state;
therapeutic use, newborn P96.2
Withdrawal state See Also: Dependence, drug by type, with withdrawal;
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Uncommon Infant and Newborn Problems
It can be scary when your baby is sick, especially when it is not an everyday problem like a cold or a fever. You may not know whether the problem is serious or how to treat it. If you have concerns about your baby's health, call your health care provider right away.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert P96.2 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About P96.2Overview
What is the ICD-10 code for withdrawal symptoms from therapeutic use of drugs in newborn?
The ICD-10-CM code for withdrawal symptoms from therapeutic use of drugs in newborn is P96.2 (sometimes written as P962). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is P96.2 (Other conditions originating in the perinatal period) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report withdrawal symptoms from therapeutic use of drugs in newborn on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does P96.2 group to?
When withdrawal symptoms from therapeutic use of drugs in newborn 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 P96.2 a CC or MCC?
CMS lists P96.2 as a CC (complication or comorbidity) for FY 2026. 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.
What is the ICD-9 equivalent of P96.2?
Under the General Equivalence Mappings, withdrawal symptoms from therapeutic use of drugs in newborn converts to ICD-9-CM 779.5 (NB drug withdrawal syndr). The mapping is approximate, so confirm the match fits the documentation.
What HCC is P96.2?
P96.2 (withdrawal symptoms from therapeutic use of drugs in newborn) 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 2026. It does not map to any RxHCC in the Part D prescription drug model.
Does P96.2 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, P96.2 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.
