2026 ICD-10-CM Diagnosis Code Q37.5Cleft hard and soft palate with unilateral cleft lip

ICD-10-CM Codes›Q00-Q99›Q35-Q37›Q37

ICD-10-CM Q37.5
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

Q37.5 is a billable ICD-10-CM diagnosis code for cleft hard and soft palate with unilateral cleft lip. 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. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Cleft lip or palate.

Code Identity

ICD-10-CM Code
Q37.5
Billable Status
Yes — Valid for Submission
Code Describes
Cleft hard and soft palate with unilateral cleft lip
Short Description
Cleft hard and soft palate with unilateral cleft lip
Same as the full description in the CMS dataset.
Parent Code
Q37
Cleft palate with cleft lip

Code Classification

ChapterQ00-Q99Congenital malformations, deformations and chromosomal abnormalities
SectionQ35-Q37Cleft lip and cleft palate
CategoryQ37Cleft palate with cleft lip
This CodeQ37.5Cleft hard and soft palate with unilateral cleft lip

Present on Admission (POA)Billing

Q37.5 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.

  • Cleft hard and soft palate with cleft lip
  • Cleft hard and soft palate with left cleft lip
  • Cleft hard and soft palate with left cleft lip and left alveolar process of maxilla
  • Cleft hard and soft palate with right cleft lip
  • Cleft hard and soft palate with right cleft lip and cleft of right alveolar process of maxilla
  • Cleft hard palate with left cleft lip
  • Cleft hard palate with left cleft lip and cleft of left alveolar process of maxilla
  • Cleft hard palate with right cleft lip
  • Cleft hard palate with right cleft lip and cleft of right alveolar process of maxilla
  • Cleft soft palate with left cleft lip
  • Cleft soft palate with left cleft lip and cleft of left alveolar process of maxilla
  • Cleft soft palate with right cleft lip
  • Cleft soft palate with right cleft lip and cleft of right alveolar process of maxilla
  • Cleft upper lip, upper jaw AND palate

Tabular List NotesGuidance

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

Inclusion Terms

  • Cleft hard and soft palate with cleft lip NOS

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)
        • with cleft palate
          • hard
            • with soft
    • Cleft(congenital)
      • lip (unilateral)
        • with cleft palate
          • soft
            • with hard
    • Cleft(congenital)
      • palate
        • hard
          • with
            • soft
              • with cleft lip (unilateral)
    • Cleft(congenital)
      • palate
        • soft
          • with
            • hard
              • with cleft lip (unilateral)

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

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 Q37.5 to ICD-9-CMHistory

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

ICD-9-CM
749.21 Unil cleft palat/lip-com
Approximate The match is approximate rather than exact.
ICD-9-CM
749.22 Unil cleft palat/lip-inc
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 Q37.5Overview

Is Q37.5 (Cleft palate with cleft lip) a billable code?

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

What MS-DRG does Q37.5 group to?

When cleft hard and soft palate with unilateral cleft lip 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 Q37.5 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 hard and soft palate with unilateral cleft lip on inpatient claims.

What is the ICD-9 equivalent of Q37.5?

Under the General Equivalence Mappings, cleft hard and soft palate with unilateral cleft lip converts to ICD-9-CM 749.21 (unil cleft palat/lip-com) and 749.22 (unil cleft palat/lip-inc). 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.