2026 ICD-10-CM Diagnosis Code Q36.1Cleft lip, median

ICD-10-CM Codes›Q00-Q99›Q35-Q37›Q36

ICD-10-CM Q36.1
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

Q36.1 is a billable ICD-10-CM diagnosis code for cleft lip, median. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 157 through 159. The code is exempt from POA reporting. Coders also document this condition as central cleft lip. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Cleft lip or palate.

Code Identity

ICD-10-CM Code
Q36.1
Billable Status
Yes — Valid for Submission
Code Describes
Cleft lip, median
Short Description
Cleft lip, median
Same as the full description in the CMS dataset.
Parent Code
Q36
Cleft lip

Code Classification

ChapterQ00-Q99Congenital malformations, deformations and chromosomal abnormalities
SectionQ35-Q37Cleft lip and cleft palate
CategoryQ36Cleft lip
This CodeQ36.1Cleft lip, median

Present on Admission (POA)Billing

Q36.1 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review other POA exempt codes.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Central cleft lip
  • Familial median cleft of upper and lower lip
  • Frontonasal dysplasia sequence
  • Lipoma of brain
  • Median cleft lip and cleft of alveolar process of maxilla
  • Midline cleft of lower lip
  • Pai syndrome

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

External Cause of Injuries IndexGuidance

References for this code in the External Cause of Injuries Index.

    • Cleft(congenital)
      • lip (unilateral)
        • median

Clinical ClassificationClinical

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

CCSR MAL006
Cleft lip or palate
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Cleft Lip

    congenital defect in the upper lip where the maxillary prominence fails to merge with the merged medial nasal prominences. it is thought to be caused by faulty migration of the mesoderm in the head region.

Patient EducationClinical

Cleft Lip and Palate

Cleft lip and cleft palate are birth defects that occur when a baby's lip or mouth do not form properly. They happen early during pregnancy. A baby can have a cleft lip, a cleft palate, or both.

Read the full article at MedlinePlus

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

Convert Q36.1 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
749.11 Unilat cleft lip-compl
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About Q36.1Overview

Is Q36.1 (Cleft lip) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report cleft lip, median on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does Q36.1 group to?

When cleft lip, median is the principal diagnosis on an inpatient stay, it groups to MS-DRG 157, 158, 159, with relative weights from 0.7085 to 1.7168 depending on complications. Higher weights mean higher Medicare reimbursement.

Is Q36.1 exempt from POA reporting?

Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for cleft lip, median on inpatient claims.

What is the ICD-9 equivalent of Q36.1?

Under the General Equivalence Mappings, cleft lip, median converts to ICD-9-CM 749.11 (unilat cleft lip-compl). The mapping is approximate, so confirm the match fits the documentation.

Footnotes

[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:

  • The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
  • The condition places limitations on self-care, independent living, and social interactions.