Medicare Code Edits · FY 2026 MCE v43.0
Pediatric Diagnoses (Age 0–17) ICD-10-CM
The pediatric diagnoses edit is a check in Medicare’s claim-validation software, the Medicare Code Editor (MCE). It covers the 125 ICD-10-CM diagnosis codes listed below. When one of these codes appears on a claim for an adult patient, the MCE flags the claim as an age conflict, and the hospital corrects the diagnosis or the recorded age before resubmitting.
✓ Built from the official CMS MCE v43.0 datasetEffective Oct 1, 2025 – Sep 30, 2026
125
ICD-10-CM Codes
29
Code Categories
0–17
Patient Age Range
ICD-10-CM
Diagnosis Codes in This Edit 125 codes · 29 categories
125 of 125 shown
A48 Other bacterial diseases, not elsewhere classified1 code
- A48.51 Infant botulism
B08 Other viral infections characterized by skin and mucous membrane lesions, not elsewhere classified3 codes
C93 Monocytic leukemia3 codes
E30 Disorders of puberty, not elsewhere classified2 codes
F64 Gender identity disorders1 code
- F64.2 Gender identity disorder of childhood
F84 Pervasive developmental disorders1 code
- F84.3 Other childhood disintegrative disorder
G93 Other disorders of brain1 code
- G93.7 Reye's syndrome
H26 Other cataract25 codes
- H26.001 Unspecified infantile and juvenile cataract, right eye
- H26.002 Unspecified infantile and juvenile cataract, left eye
- H26.003 Unspecified infantile and juvenile cataract, bilateral
- H26.009 Unspecified infantile and juvenile cataract, unspecified eye
- H26.011 Infantile and juvenile cortical, lamellar, or zonular cataract, right eye
- H26.012 Infantile and juvenile cortical, lamellar, or zonular cataract, left eye
- H26.013 Infantile and juvenile cortical, lamellar, or zonular cataract, bilateral
- H26.019 Infantile and juvenile cortical, lamellar, or zonular cataract, unspecified eye
- H26.031 Infantile and juvenile nuclear cataract, right eye
- H26.032 Infantile and juvenile nuclear cataract, left eye
- H26.033 Infantile and juvenile nuclear cataract, bilateral
- H26.039 Infantile and juvenile nuclear cataract, unspecified eye
- H26.041 Anterior subcapsular polar infantile and juvenile cataract, right eye
- H26.042 Anterior subcapsular polar infantile and juvenile cataract, left eye
- H26.043 Anterior subcapsular polar infantile and juvenile cataract, bilateral
- H26.049 Anterior subcapsular polar infantile and juvenile cataract, unspecified eye
- H26.051 Posterior subcapsular polar infantile and juvenile cataract, right eye
- H26.052 Posterior subcapsular polar infantile and juvenile cataract, left eye
- H26.053 Posterior subcapsular polar infantile and juvenile cataract, bilateral
- H26.059 Posterior subcapsular polar infantile and juvenile cataract, unspecified eye
- H26.061 Combined forms of infantile and juvenile cataract, right eye
- H26.062 Combined forms of infantile and juvenile cataract, left eye
- H26.063 Combined forms of infantile and juvenile cataract, bilateral
- H26.069 Combined forms of infantile and juvenile cataract, unspecified eye
- H26.09 Other infantile and juvenile cataract
L12 Pemphigoid1 code
- L12.2 Chronic bullous disease of childhood
L20 Atopic dermatitis1 code
- L20.83 Infantile (acute) (chronic) eczema
L21 Seborrheic dermatitis1 code
- L21.1 Seborrheic infantile dermatitis
L44 Other papulosquamous disorders1 code
- L44.4 Infantile papular acrodermatitis [Gianotti-Crosti]
L70 Acne1 code
- L70.4 Infantile acne
N92 Excessive, frequent and irregular menstruation1 code
- N92.2 Excessive menstruation at puberty
R04 Hemorrhage from respiratory passages1 code
- R04.81 Acute idiopathic pulmonary hemorrhage in infants
R10 Abdominal and pelvic pain1 code
- R10.83 Colic
R62 Lack of expected normal physiological development in childhood and adults2 codes
R63 Symptoms and signs concerning food and fluid intake2 codes
R68 Other general symptoms and signs4 codes
T74 Adult and child abuse, neglect and other maltreatment, confirmed27 codes
- T74.02XA Child neglect or abandonment, confirmed, initial encounter
- T74.02XD Child neglect or abandonment, confirmed, subsequent encounter
- T74.02XS Child neglect or abandonment, confirmed, sequela
- T74.12XA Child physical abuse, confirmed, initial encounter
- T74.12XD Child physical abuse, confirmed, subsequent encounter
- T74.12XS Child physical abuse, confirmed, sequela
- T74.22XA Child sexual abuse, confirmed, initial encounter
- T74.22XD Child sexual abuse, confirmed, subsequent encounter
- T74.22XS Child sexual abuse, confirmed, sequela
- T74.32XA Child psychological abuse, confirmed, initial encounter
- T74.32XD Child psychological abuse, confirmed, subsequent encounter
- T74.32XS Child psychological abuse, confirmed, sequela
- T74.4XXA Shaken infant syndrome, initial encounter
- T74.4XXD Shaken infant syndrome, subsequent encounter
- T74.4XXS Shaken infant syndrome, sequela
- T74.52XA Child sexual exploitation, confirmed, initial encounter
- T74.52XD Child sexual exploitation, confirmed, subsequent encounter
- T74.52XS Child sexual exploitation, confirmed, sequela
- T74.62XA Child forced labor exploitation, confirmed, initial encounter
- T74.62XD Child forced labor exploitation, confirmed, subsequent encounter
- T74.62XS Child forced labor exploitation, confirmed, sequela
- T74.92XA Unspecified child maltreatment, confirmed, initial encounter
- T74.92XD Unspecified child maltreatment, confirmed, subsequent encounter
- T74.92XS Unspecified child maltreatment, confirmed, sequela
- T74.A2XA Child financial abuse, confirmed, initial encounter
- T74.A2XD Child financial abuse, confirmed, subsequent encounter
- T74.A2XS Child financial abuse, confirmed, sequela
T76 Adult and child abuse, neglect and other maltreatment, suspected24 codes
- T76.02XA Child neglect or abandonment, suspected, initial encounter
- T76.02XD Child neglect or abandonment, suspected, subsequent encounter
- T76.02XS Child neglect or abandonment, suspected, sequela
- T76.12XA Child physical abuse, suspected, initial encounter
- T76.12XD Child physical abuse, suspected, subsequent encounter
- T76.12XS Child physical abuse, suspected, sequela
- T76.22XA Child sexual abuse, suspected, initial encounter
- T76.22XD Child sexual abuse, suspected, subsequent encounter
- T76.22XS Child sexual abuse, suspected, sequela
- T76.32XA Child psychological abuse, suspected, initial encounter
- T76.32XD Child psychological abuse, suspected, subsequent encounter
- T76.32XS Child psychological abuse, suspected, sequela
- T76.52XA Child sexual exploitation, suspected, initial encounter
- T76.52XD Child sexual exploitation, suspected, subsequent encounter
- T76.52XS Child sexual exploitation, suspected, sequela
- T76.62XA Child forced labor exploitation, suspected, initial encounter
- T76.62XD Child forced labor exploitation, suspected, subsequent encounter
- T76.62XS Child forced labor exploitation, suspected, sequela
- T76.92XA Unspecified child maltreatment, suspected, initial encounter
- T76.92XD Unspecified child maltreatment, suspected, subsequent encounter
- T76.92XS Unspecified child maltreatment, suspected, sequela
- T76.A2XA Child financial abuse, suspected, initial encounter
- T76.A2XD Child financial abuse, suspected, subsequent encounter
- T76.A2XS Child financial abuse, suspected, sequela
Z00 Encounter for general examination without complaint, suspected or reported diagnosis6 codes
- Z00.121 Encounter for routine child health examination with abnormal findings
- Z00.129 Encounter for routine child health examination without abnormal findings
- Z00.2 Encounter for examination for period of rapid growth in childhood
- Z00.3 Encounter for examination for adolescent development state
- Z00.70 Encounter for examination for period of delayed growth in childhood without abnormal findings
- Z00.71 Encounter for examination for period of delayed growth in childhood with abnormal findings
Z02 Encounter for administrative examination1 code
- Z02.84 Encounter for child welfare exam
Z04 Encounter for examination and observation for other reasons2 codes
Z62 Problems related to upbringing4 codes
Z69 Encounter for mental health services for victim and perpetrator of abuse2 codes
Z72 Problems related to lifestyle1 code
- Z72.810 Child and adolescent antisocial behavior
Z73 Problems related to life management difficulty4 codes
Z76 Persons encountering health services in other circumstances1 code
- Z76.2 Encounter for health supervision and care of other healthy infant and child
Questions About This Code Edit
What is the pediatric diagnoses Medicare code edit?
The Medicare Code Editor detects inconsistencies in pediatric cases by checking a patient's age and any diagnosis on the patient's record. The pediatric code edits apply to patients age range is 0–17 years inclusive (e.g., Reye's syndrome, routine child health exam). Claims that fail the check are flagged for correction before payment.
How many ICD-10-CM codes are on the pediatric diagnoses list?
The FY 2026 list contains 125 diagnosis codes across 29 code categories, imported from the CMS Definitions of Medicare Code Edits v43.0.
What happens when a claim triggers this edit?
When one of these codes appears on a claim for an adult patient, the MCE flags the claim as an age conflict, and the hospital corrects the diagnosis or the recorded age before resubmitting.
Does this edit make the codes invalid for billing?
No. Every code on this list is a valid ICD-10-CM code. The edit checks how the code is used on the claim, not whether the code exists.
Other ICD-10-CM Medicare Code Edits
Adult DiagnosesNewborn DiagnosesMaternity DiagnosesManifestation DiagnosesQuestionable AdmissionUnacceptable Principal DiagnosisOutcome of DeliveryUnspecified Codes
Source: CMS Definitions of Medicare Code Edits v43.0, effective October 1, 2025 through September 30, 2026. Code lists are imported directly from the official manual. See also the ICD-10-PCS procedure edits and the MS-DRG list.
