Medicare Code Edits · FY 2026 MCE v43.0

Diagnoses for Females Only ICD-10-CM

Deactivated by CMS as of October 1, 2024

This edit checked inpatient claims for consistency between the patient's recorded sex and diagnoses applicable only to female patients, such as gynecological and obstetric conditions. CMS deactivated the sex conflict edit (MCE edit 5) as of October 1, 2024, so these checks are no longer enforced during Medicare claims processing and the manual no longer publishes a code list.

Active Medicare Code Edits

Adult Diagnoses Newborn Diagnoses Pediatric Diagnoses Maternity Diagnoses Manifestation Diagnoses Questionable Admission Unacceptable Principal Diagnosis Outcome of Delivery Unspecified Codes

Source: CMS Definitions of Medicare Code Edits v43.0. This page is kept for reference; the edit is no longer part of Medicare claims processing.