CCM · Behavioral Health
CCM Qualifying Diagnoses
for Behavioral Health.
520 ICD-10-CM codes cover behavioral health patients for Chronic Care Management (CCM).
Qualifying Codes
ICD-10 codes for behavioral health.
Behavioral health and substance use
Depressive disorders
F32, F33, F34.120 codesbhiccmPHQ-9 at defined intervals, with the score trend recorded in the care plan.
Depressive disorders
F32, F33, F34.120 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Depressive Disorders · Devices: Patient-reported outcome app (RTM)
Read the depressive disorders monitoring guide
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F32.0 | Major depressive disorder, single episode, mild | bhiccm | not risk adjusted |
| F32.1 | Major depressive disorder, single episode, moderate | bhiccm | HCC 155 · Major Depression, Moderate or Severe, without Psychosis |
| F32.2 | Major depressive disorder, single episode, severe without psychotic features | bhiccm | HCC 155 · Major Depression, Moderate or Severe, without Psychosis |
| F32.3 | Major depressive disorder, single episode, severe with psychotic features | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F32.4 | Major depressive disorder, single episode, in partial remission | bhiccm | not risk adjusted |
| F32.5 | Major depressive disorder, single episode, in full remission | bhiccm | not risk adjusted |
| F32.81 | Premenstrual dysphoric disorder | bhiccm | not risk adjusted |
| F32.89 | Other specified depressive episodes | bhiccm | not risk adjusted |
| F32.9 | Major depressive disorder, single episode, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F32.A | Depression, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F33.0 | Major depressive disorder, recurrent, mild | bhiccm | not risk adjusted |
| F33.1 | Major depressive disorder, recurrent, moderate | bhiccm | HCC 155 · Major Depression, Moderate or Severe, without Psychosis |
| F33.2 | Major depressive disorder, recurrent severe without psychotic features | bhiccm | HCC 155 · Major Depression, Moderate or Severe, without Psychosis |
| F33.3 | Major depressive disorder, recurrent, severe with psychotic symptoms | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F33.40 | Major depressive disorder, recurrent, in remission, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F33.41 | Major depressive disorder, recurrent, in partial remission | bhiccm | not risk adjusted |
| F33.42 | Major depressive disorder, recurrent, in full remission | bhiccm | not risk adjusted |
| F33.8 | Other recurrent depressive disorders | bhiccm | not risk adjusted |
| F33.9 | Major depressive disorder, recurrent, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F34.1 | Dysthymic disorder | bhiccm | not risk adjusted |
Bipolar and related disorders
F30, F31, F34.038 codesbhiccmMood tracking and medication adherence, with laboratory monitoring where a mood stabilizer requires it.
Bipolar and related disorders
F30, F31, F34.038 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Bipolar Disorder · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F30.10 | Manic episode without psychotic symptoms, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.11 | Manic episode without psychotic symptoms, mild | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.12 | Manic episode without psychotic symptoms, moderate | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.13 | Manic episode, severe, without psychotic symptoms | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.2 | Manic episode, severe with psychotic symptoms | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F30.3 | Manic episode in partial remission | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.4 | Manic episode in full remission | bhiccm | not risk adjusted |
| F30.8 | Other manic episodes | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F30.9 | Manic episode, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.0 | Bipolar disorder, current episode hypomanic | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.10 | Bipolar disorder, current episode manic without psychotic features, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.11 | Bipolar disorder, current episode manic without psychotic features, mild | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.12 | Bipolar disorder, current episode manic without psychotic features, moderate | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.13 | Bipolar disorder, current episode manic without psychotic features, severe | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.2 | Bipolar disorder, current episode manic severe with psychotic features | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F31.30 | Bipolar disorder, current episode depressed, mild or moderate severity, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.31 | Bipolar disorder, current episode depressed, mild | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.32 | Bipolar disorder, current episode depressed, moderate | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.4 | Bipolar disorder, current episode depressed, severe, without psychotic features | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.5 | Bipolar disorder, current episode depressed, severe, with psychotic features | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F31.60 | Bipolar disorder, current episode mixed, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.61 | Bipolar disorder, current episode mixed, mild | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.62 | Bipolar disorder, current episode mixed, moderate | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.63 | Bipolar disorder, current episode mixed, severe, without psychotic features | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.64 | Bipolar disorder, current episode mixed, severe, with psychotic features | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F31.70 | Bipolar disorder, currently in remission, most recent episode unspecifiedlow specificity | bhiccm | not risk adjusted |
| F31.71 | Bipolar disorder, in partial remission, most recent episode hypomanic | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.72 | Bipolar disorder, in full remission, most recent episode hypomanic | bhiccm | not risk adjusted |
| F31.73 | Bipolar disorder, in partial remission, most recent episode manic | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.74 | Bipolar disorder, in full remission, most recent episode manic | bhiccm | not risk adjusted |
| F31.75 | Bipolar disorder, in partial remission, most recent episode depressed | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.76 | Bipolar disorder, in full remission, most recent episode depressed | bhiccm | not risk adjusted |
| F31.77 | Bipolar disorder, in partial remission, most recent episode mixed | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.78 | Bipolar disorder, in full remission, most recent episode mixed | bhiccm | not risk adjusted |
| F31.81 | Bipolar II disorder | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.89 | Other bipolar disorder | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F31.9 | Bipolar disorder, unspecified | bhiccm | HCC 154 · Bipolar Disorders without Psychosis |
| F34.0 | Cyclothymic disorder | bhiccm | not risk adjusted |
Anxiety and fear-related disorders
F40, F4128 codesbhiccmGAD-7 at defined intervals.
Anxiety and fear-related disorders
F40, F4128 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Anxiety Disorders · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F40.00 | Agoraphobia, unspecified | bhiccm | not risk adjusted |
| F40.01 | Agoraphobia with panic disorder | bhiccm | not risk adjusted |
| F40.02 | Agoraphobia without panic disorder | bhiccm | not risk adjusted |
| F40.10 | Social phobia, unspecified | bhiccm | not risk adjusted |
| F40.11 | Social phobia, generalized | bhiccm | not risk adjusted |
| F40.210 | Arachnophobia | bhiccm | not risk adjusted |
| F40.218 | Other animal type phobia | bhiccm | not risk adjusted |
| F40.220 | Fear of thunderstorms | bhiccm | not risk adjusted |
| F40.228 | Other natural environment type phobia | bhiccm | not risk adjusted |
| F40.230 | Fear of blood | bhiccm | not risk adjusted |
| F40.231 | Fear of injections and transfusions | bhiccm | not risk adjusted |
| F40.232 | Fear of other medical care | bhiccm | not risk adjusted |
| F40.233 | Fear of injury | bhiccm | not risk adjusted |
| F40.240 | Claustrophobia | bhiccm | not risk adjusted |
| F40.241 | Acrophobia | bhiccm | not risk adjusted |
| F40.242 | Fear of bridges | bhiccm | not risk adjusted |
| F40.243 | Fear of flying | bhiccm | not risk adjusted |
| F40.248 | Other situational type phobia | bhiccm | not risk adjusted |
| F40.290 | Androphobia | bhiccm | not risk adjusted |
| F40.291 | Gynephobia | bhiccm | not risk adjusted |
| F40.298 | Other specified phobia | bhiccm | not risk adjusted |
| F40.8 | Other phobic anxiety disorders | bhiccm | not risk adjusted |
| F40.9 | Phobic anxiety disorder, unspecified | bhiccm | not risk adjusted |
| F41.0 | Panic disorder [episodic paroxysmal anxiety] | bhiccm | not risk adjusted |
| F41.1 | Generalized anxiety disorder | bhiccm | not risk adjusted |
| F41.3 | Other mixed anxiety disorders | bhiccm | not risk adjusted |
| F41.8 | Other specified anxiety disorders | bhiccm | not risk adjusted |
| F41.9 | Anxiety disorder, unspecified | bhiccm | not risk adjusted |
Trauma and stressor-related disorders
F4314 codesbhiccmPCL-5 or an equivalent validated instrument.
Trauma and stressor-related disorders
F4314 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Post-Traumatic Stress Disorder (PTSD) · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F43.0 | Acute stress reaction | bhiccm | not risk adjusted |
| F43.10 | Post-traumatic stress disorder, unspecified | bhiccm | not risk adjusted |
| F43.11 | Post-traumatic stress disorder, acute | bhiccm | not risk adjusted |
| F43.12 | Post-traumatic stress disorder, chronic | bhiccm | not risk adjusted |
| F43.20 | Adjustment disorder, unspecified | bhiccm | not risk adjusted |
| F43.21 | Adjustment disorder with depressed mood | bhiccm | not risk adjusted |
| F43.22 | Adjustment disorder with anxiety | bhiccm | not risk adjusted |
| F43.23 | Adjustment disorder with mixed anxiety and depressed mood | bhiccm | not risk adjusted |
| F43.24 | Adjustment disorder with disturbance of conduct | bhiccm | not risk adjusted |
| F43.25 | Adjustment disorder with mixed disturbance of emotions and conduct | bhiccm | not risk adjusted |
| F43.29 | Adjustment disorder with other symptoms | bhiccm | not risk adjusted |
| F43.81 | Prolonged grief disorder | bhiccm | not risk adjusted |
| F43.89 | Other reactions to severe stress | bhiccm | not risk adjusted |
| F43.9 | Reaction to severe stress, unspecified | bhiccm | not risk adjusted |
Schizophrenia and other psychotic disorders
F20, F21, F22, F23, F24, F25, F28, F2918 codesbhiccmAdherence and metabolic surveillance, since antipsychotics drive weight and glucose change.
Schizophrenia and other psychotic disorders
F20, F21, F22, F23, F24, F25, F28, F2918 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Schizophrenia and Other Psychotic Disorders · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F20.0 | Paranoid schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.1 | Disorganized schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.2 | Catatonic schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.3 | Undifferentiated schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.5 | Residual schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.81 | Schizophreniform disorder | bhiccm | HCC 151 · Schizophrenia |
| F20.89 | Other schizophrenia | bhiccm | HCC 151 · Schizophrenia |
| F20.9 | Schizophrenia, unspecified | bhiccm | HCC 151 · Schizophrenia |
| F21 | Schizotypal disorder | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F22 | Delusional disorders | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F23 | Brief psychotic disorder | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F24 | Shared psychotic disorder | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F25.0 | Schizoaffective disorder, bipolar type | bhiccm | HCC 151 · Schizophrenia |
| F25.1 | Schizoaffective disorder, depressive type | bhiccm | HCC 151 · Schizophrenia |
| F25.8 | Other schizoaffective disorders | bhiccm | HCC 151 · Schizophrenia |
| F25.9 | Schizoaffective disorder, unspecified | bhiccm | HCC 151 · Schizophrenia |
| F28 | Other psychotic disorder not due to a substance or known physiological condition | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
| F29 | Unspecified psychosis not due to a substance or known physiological condition | bhiccm | HCC 152 · Psychosis, Except Schizophrenia |
Feeding and eating disorders
F5030 codesbhiccmWeight monitoring under an explicit protocol, with behavioral follow-up.
Feeding and eating disorders
F5030 codesbhiccmAdded by CCN Health · Devices: Connected weight scale
F50.2 is no longer valid. Bulimia nervosa is now F50.20 through F50.25.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F50.00 | Anorexia nervosa, unspecified | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.010 | Anorexia nervosa, restricting type, mild | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.011 | Anorexia nervosa, restricting type, moderate | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.012 | Anorexia nervosa, restricting type, severe | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.013 | Anorexia nervosa, restricting type, extreme | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.014 | Anorexia nervosa, restricting type, in remission | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.019 | Anorexia nervosa, restricting type, unspecified | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.020 | Anorexia nervosa, binge eating/purging type, mild | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.021 | Anorexia nervosa, binge eating/purging type, moderate | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.022 | Anorexia nervosa, binge eating/purging type, severe | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.023 | Anorexia nervosa, binge eating/purging type, extreme | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.024 | Anorexia nervosa, binge eating/purging type, in remission | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.029 | Anorexia nervosa, binge eating/purging type, unspecified | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.20 | Bulimia nervosa, unspecified | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.21 | Bulimia nervosa, mild | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.22 | Bulimia nervosa, moderate | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.23 | Bulimia nervosa, severe | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.24 | Bulimia nervosa, extreme | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.25 | Bulimia nervosa, in remission | bhiccm | HCC 153 · Personality Disorders; Anorexia/Bulimia Nervosa |
| F50.810 | Binge eating disorder, mild | bhiccm | not risk adjusted |
| F50.811 | Binge eating disorder, moderate | bhiccm | not risk adjusted |
| F50.812 | Binge eating disorder, severe | bhiccm | not risk adjusted |
| F50.813 | Binge eating disorder, extreme | bhiccm | not risk adjusted |
| F50.814 | Binge eating disorder, in remission | bhiccm | not risk adjusted |
| F50.819 | Binge eating disorder, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F50.82 | Avoidant/restrictive food intake disorder | bhiccm | not risk adjusted |
| F50.83 | Pica in adults | bhiccm | not risk adjusted |
| F50.84 | Rumination disorder in adults | bhiccm | not risk adjusted |
| F50.89 | Other specified eating disorder | bhiccm | not risk adjusted |
| F50.9 | Eating disorder, unspecifiedlow specificity | bhiccm | not risk adjusted |
Alcohol-related disorders
F1058 codesbhiccmAUDIT-C and structured relapse-risk follow-up.
Alcohol-related disorders
F1058 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Alcohol Use Disorders · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F10.10 | Alcohol abuse, uncomplicated | bhiccm | not risk adjusted |
| F10.11 | Alcohol abuse, in remission | bhiccm | not risk adjusted |
| F10.120 | Alcohol abuse with intoxication, uncomplicated | bhiccm | not risk adjusted |
| F10.121 | Alcohol abuse with intoxication delirium | bhiccm | not risk adjusted |
| F10.129 | Alcohol abuse with intoxication, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F10.130 | Alcohol abuse with withdrawal, uncomplicated | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.131 | Alcohol abuse with withdrawal delirium | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.132 | Alcohol abuse with withdrawal with perceptual disturbance | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.139 | Alcohol abuse with withdrawal, unspecified | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.14 | Alcohol abuse with alcohol-induced mood disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.150 | Alcohol abuse with alcohol-induced psychotic disorder with delusions | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.151 | Alcohol abuse with alcohol-induced psychotic disorder with hallucinations | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.159 | Alcohol abuse with alcohol-induced psychotic disorder, unspecified | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.180 | Alcohol abuse with alcohol-induced anxiety disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.181 | Alcohol abuse with alcohol-induced sexual dysfunction | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.182 | Alcohol abuse with alcohol-induced sleep disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.188 | Alcohol abuse with other alcohol-induced disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.19 | Alcohol abuse with unspecified alcohol-induced disorderlow specificity | bhiccm | not risk adjusted |
| F10.20 | Alcohol dependence, uncomplicated | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.21 | Alcohol dependence, in remission | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.220 | Alcohol dependence with intoxication, uncomplicated | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.221 | Alcohol dependence with intoxication delirium | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.229 | Alcohol dependence with intoxication, unspecified | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.230 | Alcohol dependence with withdrawal, uncomplicated | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.231 | Alcohol dependence with withdrawal delirium | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.232 | Alcohol dependence with withdrawal with perceptual disturbance | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.239 | Alcohol dependence with withdrawal, unspecified | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.24 | Alcohol dependence with alcohol-induced mood disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.250 | Alcohol dependence with alcohol-induced psychotic disorder with delusions | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.259 | Alcohol dependence with alcohol-induced psychotic disorder, unspecified | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.26 | Alcohol dependence with alcohol-induced persisting amnestic disorder | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.27 | Alcohol dependence with alcohol-induced persisting dementia | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.280 | Alcohol dependence with alcohol-induced anxiety disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.281 | Alcohol dependence with alcohol-induced sexual dysfunction | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.282 | Alcohol dependence with alcohol-induced sleep disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.288 | Alcohol dependence with other alcohol-induced disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.29 | Alcohol dependence with unspecified alcohol-induced disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.90 | Alcohol use, unspecified, uncomplicatedlow specificity | bhiccm | not risk adjusted |
| F10.91 | Alcohol use, unspecified, in remissionlow specificity | bhiccm | not risk adjusted |
| F10.920 | Alcohol use, unspecified with intoxication, uncomplicatedlow specificity | bhiccm | not risk adjusted |
| F10.921 | Alcohol use, unspecified with intoxication deliriumlow specificity | bhiccm | not risk adjusted |
| F10.929 | Alcohol use, unspecified with intoxication, unspecifiedlow specificity | bhiccm | not risk adjusted |
| F10.930 | Alcohol use, unspecified with withdrawal, uncomplicated | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.931 | Alcohol use, unspecified with withdrawal delirium | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.932 | Alcohol use, unspecified with withdrawal with perceptual disturbance | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.939 | Alcohol use, unspecified with withdrawal, unspecified | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.94 | Alcohol use, unspecified with alcohol-induced mood disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.950 | Alcohol use, unspecified with alcohol-induced psychotic disorder with delusions | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.951 | Alcohol use, unspecified with alcohol-induced psychotic disorder with hallucinations | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.959 | Alcohol use, unspecified with alcohol-induced psychotic disorder, unspecified | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.96 | Alcohol use, unspecified with alcohol-induced persisting amnestic disorder | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.97 | Alcohol use, unspecified with alcohol-induced persisting dementia | bhiccm | HCC 136 · Alcohol Use with Psychotic Complications |
| F10.980 | Alcohol use, unspecified with alcohol-induced anxiety disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.981 | Alcohol use, unspecified with alcohol-induced sexual dysfunction | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.982 | Alcohol use, unspecified with alcohol-induced sleep disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.988 | Alcohol use, unspecified with other alcohol-induced disorder | bhiccm | HCC 139 · Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications |
| F10.99 | Alcohol use, unspecified with unspecified alcohol-induced disorderlow specificity | bhiccm | not risk adjusted |
Opioid-related disorders
F1145 codesbhiccmMedication-assisted therapy adherence and structured follow-up.
Opioid-related disorders
F1145 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Opioid Use Disorder (OUD) · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F11.10 | Opioid abuse, uncomplicated | bhiccm | HCC 138 · Drug Use Disorder, Mild, Uncomplicated, Except Cannabis |
| F11.11 | Opioid abuse, in remission | bhiccm | HCC 138 · Drug Use Disorder, Mild, Uncomplicated, Except Cannabis |
| F11.120 | Opioid abuse with intoxication, uncomplicated | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.121 | Opioid abuse with intoxication delirium | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.122 | Opioid abuse with intoxication with perceptual disturbance | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.129 | Opioid abuse with intoxication, unspecified | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.13 | Opioid abuse with withdrawal | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.14 | Opioid abuse with opioid-induced mood disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.150 | Opioid abuse with opioid-induced psychotic disorder with delusions | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.151 | Opioid abuse with opioid-induced psychotic disorder with hallucinations | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.159 | Opioid abuse with opioid-induced psychotic disorder, unspecified | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.181 | Opioid abuse with opioid-induced sexual dysfunction | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.182 | Opioid abuse with opioid-induced sleep disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.188 | Opioid abuse with other opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.19 | Opioid abuse with unspecified opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.20 | Opioid dependence, uncomplicated | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.21 | Opioid dependence, in remission | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.220 | Opioid dependence with intoxication, uncomplicated | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.221 | Opioid dependence with intoxication delirium | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.222 | Opioid dependence with intoxication with perceptual disturbance | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.229 | Opioid dependence with intoxication, unspecified | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.23 | Opioid dependence with withdrawal | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.24 | Opioid dependence with opioid-induced mood disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.250 | Opioid dependence with opioid-induced psychotic disorder with delusions | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.251 | Opioid dependence with opioid-induced psychotic disorder with hallucinations | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.259 | Opioid dependence with opioid-induced psychotic disorder, unspecified | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.281 | Opioid dependence with opioid-induced sexual dysfunction | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.282 | Opioid dependence with opioid-induced sleep disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.288 | Opioid dependence with other opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.29 | Opioid dependence with unspecified opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.90 | Opioid use, unspecified, uncomplicatedlow specificity | bhiccm | not risk adjusted |
| F11.91 | Opioid use, unspecified, in remissionlow specificity | bhiccm | not risk adjusted |
| F11.920 | Opioid use, unspecified with intoxication, uncomplicated | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.921 | Opioid use, unspecified with intoxication delirium | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.922 | Opioid use, unspecified with intoxication with perceptual disturbance | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.929 | Opioid use, unspecified with intoxication, unspecified | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.93 | Opioid use, unspecified with withdrawal | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.94 | Opioid use, unspecified with opioid-induced mood disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.950 | Opioid use, unspecified with opioid-induced psychotic disorder with delusions | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.951 | Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.959 | Opioid use, unspecified with opioid-induced psychotic disorder, unspecified | bhiccm | HCC 135 · Drug Use with Psychotic Complications |
| F11.981 | Opioid use, unspecified with opioid-induced sexual dysfunction | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.982 | Opioid use, unspecified with opioid-induced sleep disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.988 | Opioid use, unspecified with other opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
| F11.99 | Opioid use, unspecified with unspecified opioid-induced disorder | bhiccm | HCC 137 · Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications |
Other substance-related disorders
F12, F13, F14, F15, F16, F18, F19335 codes in familybhiccmStructured follow-up and relapse-risk assessment.
Other substance-related disorders
F12, F13, F14, F15, F16, F18, F19335 codes in familybhiccmCMS other chronic or potentially disabling condition · CCW category: Drug Use Disorders · Devices: Patient-reported outcome app (RTM)
This family runs to 335 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within F12, F13, F14, F15, F16, F18, F19.
Tobacco-related disorders
F17, Z87.89121 codesbhiccmCessation counselling and relapse follow-up.
Tobacco-related disorders
F17, Z87.89121 codesbhiccmCMS other chronic or potentially disabling condition · CCW category: Tobacco Use Disorders
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F17.200 | Nicotine dependence, unspecified, uncomplicated | bhiccm | not risk adjusted |
| F17.201 | Nicotine dependence, unspecified, in remission | bhiccm | not risk adjusted |
| F17.203 | Nicotine dependence unspecified, with withdrawal | bhiccm | not risk adjusted |
| F17.208 | Nicotine dependence, unspecified, with other nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.209 | Nicotine dependence, unspecified, with unspecified nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.210 | Nicotine dependence, cigarettes, uncomplicated | bhiccm | not risk adjusted |
| F17.211 | Nicotine dependence, cigarettes, in remission | bhiccm | not risk adjusted |
| F17.213 | Nicotine dependence, cigarettes, with withdrawal | bhiccm | not risk adjusted |
| F17.218 | Nicotine dependence, cigarettes, with other nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.219 | Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.220 | Nicotine dependence, chewing tobacco, uncomplicated | bhiccm | not risk adjusted |
| F17.221 | Nicotine dependence, chewing tobacco, in remission | bhiccm | not risk adjusted |
| F17.223 | Nicotine dependence, chewing tobacco, with withdrawal | bhiccm | not risk adjusted |
| F17.228 | Nicotine dependence, chewing tobacco, with other nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.229 | Nicotine dependence, chewing tobacco, with unspecified nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.290 | Nicotine dependence, other tobacco product, uncomplicated | bhiccm | not risk adjusted |
| F17.291 | Nicotine dependence, other tobacco product, in remission | bhiccm | not risk adjusted |
| F17.293 | Nicotine dependence, other tobacco product, with withdrawal | bhiccm | not risk adjusted |
| F17.298 | Nicotine dependence, other tobacco product, with other nicotine-induced disorders | bhiccm | not risk adjusted |
| F17.299 | Nicotine dependence, other tobacco product, with unspecified nicotine-induced disorders | bhiccm | not risk adjusted |
| Z87.891 | Personal history of nicotine dependence | bhiccm | not risk adjusted |
Autism spectrum and intellectual disabilities
F84, F70, F71, F72, F73, F78, F7913 codes in familybhiccmCare coordination and caregiver support rather than device data.
Autism spectrum and intellectual disabilities
F84, F70, F71, F72, F73, F78, F7913 codes in familybhiccmCMS other chronic or potentially disabling condition · CCW category: Autism Spectrum Disorders
This family runs to 13 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within F84, F70, F71, F72, F73, F78, F79.
Neurologic and cognitive
Alzheimer's disease
G304 codesccmpcmActivity, night-time movement and fall detection, with caregiver-reported change.
Alzheimer's disease
G304 codesccmpcmCMS chronic condition · CCW category: Alzheimer's Disease · Devices: Contactless activity and fall radar
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G30.0 | Alzheimer's disease with early onset | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G30.1 | Alzheimer's disease with late onset | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G30.8 | Other Alzheimer's disease | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G30.9 | Alzheimer's disease, unspecified | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
Non-Alzheimer's dementia
F01, F02, F03, G31, G13.2, G13.888 codesccmpcmActivity and fall detection with caregiver-reported change.
Non-Alzheimer's dementia
F01, F02, F03, G31, G13.2, G13.888 codesccmpcmCMS chronic condition · CCW category: Non-Alzheimer's Dementia · Devices: Contactless activity and fall radar
F01, F02 and F03 now require severity and a behavioural qualifier. F03.91 is no longer valid on its own.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| F01.50 | Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.511 | Vascular dementia, unspecified severity, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.518 | Vascular dementia, unspecified severity, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.52 | Vascular dementia, unspecified severity, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.53 | Vascular dementia, unspecified severity, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.54 | Vascular dementia, unspecified severity, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A0 | Vascular dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A11 | Vascular dementia, mild, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A18 | Vascular dementia, mild, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A2 | Vascular dementia, mild, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A3 | Vascular dementia, mild, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.A4 | Vascular dementia, mild, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F01.B0 | Vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.B11 | Vascular dementia, moderate, with agitation | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.B18 | Vascular dementia, moderate, with other behavioral disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.B2 | Vascular dementia, moderate, with psychotic disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.B3 | Vascular dementia, moderate, with mood disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.B4 | Vascular dementia, moderate, with anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F01.C0 | Vascular dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| F01.C11 | Vascular dementia, severe, with agitation | ccmpcm | HCC 125 · Dementia, Severe |
| F01.C18 | Vascular dementia, severe, with other behavioral disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F01.C2 | Vascular dementia, severe, with psychotic disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F01.C3 | Vascular dementia, severe, with mood disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F01.C4 | Vascular dementia, severe, with anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| F02.80 | Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.811 | Dementia in other diseases classified elsewhere, unspecified severity, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.818 | Dementia in other diseases classified elsewhere, unspecified severity, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.82 | Dementia in other diseases classified elsewhere, unspecified severity, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.83 | Dementia in other diseases classified elsewhere, unspecified severity, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.84 | Dementia in other diseases classified elsewhere, unspecified severity, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A0 | Dementia in other diseases classified elsewhere, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A11 | Dementia in other diseases classified elsewhere, mild, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A18 | Dementia in other diseases classified elsewhere, mild, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A2 | Dementia in other diseases classified elsewhere, mild, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A3 | Dementia in other diseases classified elsewhere, mild, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.A4 | Dementia in other diseases classified elsewhere, mild, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F02.B0 | Dementia in other diseases classified elsewhere, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.B11 | Dementia in other diseases classified elsewhere, moderate, with agitation | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.B18 | Dementia in other diseases classified elsewhere, moderate, with other behavioral disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.B2 | Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.B3 | Dementia in other diseases classified elsewhere, moderate, with mood disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.B4 | Dementia in other diseases classified elsewhere, moderate, with anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F02.C0 | Dementia in other diseases classified elsewhere, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| F02.C11 | Dementia in other diseases classified elsewhere, severe, with agitation | ccmpcm | HCC 125 · Dementia, Severe |
| F02.C18 | Dementia in other diseases classified elsewhere, severe, with other behavioral disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F02.C2 | Dementia in other diseases classified elsewhere, severe, with psychotic disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F02.C3 | Dementia in other diseases classified elsewhere, severe, with mood disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F02.C4 | Dementia in other diseases classified elsewhere, severe, with anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| F03.90 | Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.911 | Unspecified dementia, unspecified severity, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.918 | Unspecified dementia, unspecified severity, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.92 | Unspecified dementia, unspecified severity, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.93 | Unspecified dementia, unspecified severity, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.94 | Unspecified dementia, unspecified severity, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A0 | Unspecified dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A11 | Unspecified dementia, mild, with agitation | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A18 | Unspecified dementia, mild, with other behavioral disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A2 | Unspecified dementia, mild, with psychotic disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A3 | Unspecified dementia, mild, with mood disturbance | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.A4 | Unspecified dementia, mild, with anxiety | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| F03.B0 | Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.B11 | Unspecified dementia, moderate, with agitation | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.B18 | Unspecified dementia, moderate, with other behavioral disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.B2 | Unspecified dementia, moderate, with psychotic disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.B3 | Unspecified dementia, moderate, with mood disturbance | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.B4 | Unspecified dementia, moderate, with anxiety | ccmpcm | HCC 126 · Dementia, Moderate |
| F03.C0 | Unspecified dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| F03.C11 | Unspecified dementia, severe, with agitation | ccmpcm | HCC 125 · Dementia, Severe |
| F03.C18 | Unspecified dementia, severe, with other behavioral disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F03.C2 | Unspecified dementia, severe, with psychotic disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F03.C3 | Unspecified dementia, severe, with mood disturbance | ccmpcm | HCC 125 · Dementia, Severe |
| F03.C4 | Unspecified dementia, severe, with anxiety | ccmpcm | HCC 125 · Dementia, Severe |
| G13.2 | Systemic atrophy primarily affecting the central nervous system in myxedema | ccmpcm | not risk adjusted |
| G13.8 | Systemic atrophy primarily affecting central nervous system in other diseases classified elsewhere | ccmpcm | not risk adjusted |
| G31.01 | Pick's disease | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.09 | Other frontotemporal neurocognitive disorder | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.1 | Senile degeneration of brain, not elsewhere classified | ccmpcm | not risk adjusted |
| G31.2 | Degeneration of nervous system due to alcohol | ccmpcm | not risk adjusted |
| G31.80 | Leukodystrophy, unspecified | ccmpcm | HCC 200 · Friedreich and Other Hereditary Ataxias; Huntington Disease |
| G31.81 | Alpers disease | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.82 | Leigh's disease | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.83 | Neurocognitive disorder with Lewy bodies | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.84 | Mild cognitive impairment of uncertain or unknown etiology | ccmpcm | not risk adjusted |
| G31.85 | Corticobasal degeneration | ccmpcm | not risk adjusted |
| G31.86 | Alexander disease | ccmpcm | HCC 127 · Dementia, Mild or Unspecified |
| G31.87 | Primary progressive apraxia of speech | ccmpcm | not risk adjusted |
| G31.89 | Other specified degenerative diseases of nervous system | ccmpcm | not risk adjusted |
| G31.9 | Degenerative disease of nervous system, unspecifiedlow specificity | ccmpcm | not risk adjusted |
Epilepsy and recurrent seizures
G4058 codesccmpcmSeizure diary and medication adherence.
Epilepsy and recurrent seizures
G4058 codesccmpcmCMS other chronic or potentially disabling condition · CCW category: Epilepsy · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G40.001 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.009 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.011 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.019 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.101 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.109 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.111 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.119 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.201 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.209 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.211 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.219 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.301 | Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.309 | Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.311 | Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.319 | Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.401 | Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.409 | Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.411 | Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.419 | Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.42 | Cyclin-Dependent Kinase-Like 5 Deficiency Disorder | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.501 | Epileptic seizures related to external causes, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.509 | Epileptic seizures related to external causes, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.801 | Other epilepsy, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.802 | Other epilepsy, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.803 | Other epilepsy, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.804 | Other epilepsy, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.811 | Lennox-Gastaut syndrome, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.812 | Lennox-Gastaut syndrome, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.813 | Lennox-Gastaut syndrome, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.814 | Lennox-Gastaut syndrome, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.821 | Epileptic spasms, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.822 | Epileptic spasms, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.823 | Epileptic spasms, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.824 | Epileptic spasms, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.833 | Dravet syndrome, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.834 | Dravet syndrome, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.841 | KCNQ2-related epilepsy, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.842 | KCNQ2-related epilepsy, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.843 | KCNQ2-related epilepsy, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.844 | KCNQ2-related epilepsy, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.89 | Other seizures | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.901 | Epilepsy, unspecified, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.909 | Epilepsy, unspecified, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.911 | Epilepsy, unspecified, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.919 | Epilepsy, unspecified, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.A01 | Absence epileptic syndrome, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.A09 | Absence epileptic syndrome, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.A11 | Absence epileptic syndrome, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.A19 | Absence epileptic syndrome, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.B01 | Juvenile myoclonic epilepsy, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.B09 | Juvenile myoclonic epilepsy, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.B11 | Juvenile myoclonic epilepsy, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.B19 | Juvenile myoclonic epilepsy, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.C01 | Lafora progressive myoclonus epilepsy, not intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.C09 | Lafora progressive myoclonus epilepsy, not intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.C11 | Lafora progressive myoclonus epilepsy, intractable, with status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
| G40.C19 | Lafora progressive myoclonus epilepsy, intractable, without status epilepticus | ccmpcm | HCC 201 · Seizure Disorders and Convulsions |
Migraine and other chronic headache
G43, G4488 codesccmrtmHeadache diary, trigger tracking and abortive-medication frequency.
Migraine and other chronic headache
G43, G4488 codesccmrtmCMS other chronic or potentially disabling condition · CCW category: Migraine and Other Chronic Headache · Devices: Patient-reported outcome app (RTM)
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G43.001 | Migraine without aura, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.009 | Migraine without aura, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.011 | Migraine without aura, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.019 | Migraine without aura, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.101 | Migraine with aura, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.109 | Migraine with aura, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.111 | Migraine with aura, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.119 | Migraine with aura, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.401 | Hemiplegic migraine, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.409 | Hemiplegic migraine, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.411 | Hemiplegic migraine, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.419 | Hemiplegic migraine, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.501 | Persistent migraine aura without cerebral infarction, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.509 | Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.511 | Persistent migraine aura without cerebral infarction, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.519 | Persistent migraine aura without cerebral infarction, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.601 | Persistent migraine aura with cerebral infarction, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.609 | Persistent migraine aura with cerebral infarction, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.611 | Persistent migraine aura with cerebral infarction, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.619 | Persistent migraine aura with cerebral infarction, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.701 | Chronic migraine without aura, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.709 | Chronic migraine without aura, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.711 | Chronic migraine without aura, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.719 | Chronic migraine without aura, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.801 | Other migraine, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.809 | Other migraine, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.811 | Other migraine, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.819 | Other migraine, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.821 | Menstrual migraine, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.829 | Menstrual migraine, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.831 | Menstrual migraine, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.839 | Menstrual migraine, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.901 | Migraine, unspecified, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.909 | Migraine, unspecified, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.911 | Migraine, unspecified, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.919 | Migraine, unspecified, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.A0 | Cyclical vomiting, in migraine, not intractable | ccmrtm | not risk adjusted |
| G43.A1 | Cyclical vomiting, in migraine, intractable | ccmrtm | not risk adjusted |
| G43.B0 | Ophthalmoplegic migraine, not intractable | ccmrtm | not risk adjusted |
| G43.B1 | Ophthalmoplegic migraine, intractable | ccmrtm | not risk adjusted |
| G43.C0 | Periodic headache syndromes in child or adult, not intractable | ccmrtm | not risk adjusted |
| G43.C1 | Periodic headache syndromes in child or adult, intractable | ccmrtm | not risk adjusted |
| G43.D0 | Abdominal migraine, not intractable | ccmrtm | not risk adjusted |
| G43.D1 | Abdominal migraine, intractable | ccmrtm | not risk adjusted |
| G43.E01 | Chronic migraine with aura, not intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.E09 | Chronic migraine with aura, not intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G43.E11 | Chronic migraine with aura, intractable, with status migrainosus | ccmrtm | not risk adjusted |
| G43.E19 | Chronic migraine with aura, intractable, without status migrainosus | ccmrtm | not risk adjusted |
| G44.001 | Cluster headache syndrome, unspecified, intractable | ccmrtm | not risk adjusted |
| G44.009 | Cluster headache syndrome, unspecified, not intractable | ccmrtm | not risk adjusted |
| G44.011 | Episodic cluster headache, intractable | ccmrtm | not risk adjusted |
| G44.019 | Episodic cluster headache, not intractable | ccmrtm | not risk adjusted |
| G44.021 | Chronic cluster headache, intractable | ccmrtm | not risk adjusted |
| G44.029 | Chronic cluster headache, not intractable | ccmrtm | not risk adjusted |
| G44.031 | Episodic paroxysmal hemicrania, intractable | ccmrtm | not risk adjusted |
| G44.039 | Episodic paroxysmal hemicrania, not intractable | ccmrtm | not risk adjusted |
| G44.041 | Chronic paroxysmal hemicrania, intractable | ccmrtm | not risk adjusted |
| G44.049 | Chronic paroxysmal hemicrania, not intractable | ccmrtm | not risk adjusted |
| G44.051 | Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), intractable | ccmrtm | not risk adjusted |
| G44.059 | Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), not intractable | ccmrtm | not risk adjusted |
| G44.091 | Other trigeminal autonomic cephalgias (TAC), intractable | ccmrtm | not risk adjusted |
| G44.099 | Other trigeminal autonomic cephalgias (TAC), not intractable | ccmrtm | not risk adjusted |
| G44.1 | Vascular headache, not elsewhere classified | ccmrtm | not risk adjusted |
| G44.201 | Tension-type headache, unspecified, intractable | ccmrtm | not risk adjusted |
| G44.209 | Tension-type headache, unspecified, not intractable | ccmrtm | not risk adjusted |
| G44.211 | Episodic tension-type headache, intractable | ccmrtm | not risk adjusted |
| G44.219 | Episodic tension-type headache, not intractable | ccmrtm | not risk adjusted |
| G44.221 | Chronic tension-type headache, intractable | ccmrtm | not risk adjusted |
| G44.229 | Chronic tension-type headache, not intractable | ccmrtm | not risk adjusted |
| G44.301 | Post-traumatic headache, unspecified, intractable | ccmrtm | not risk adjusted |
| G44.309 | Post-traumatic headache, unspecified, not intractable | ccmrtm | not risk adjusted |
| G44.311 | Acute post-traumatic headache, intractable | ccmrtm | not risk adjusted |
| G44.319 | Acute post-traumatic headache, not intractable | ccmrtm | not risk adjusted |
| G44.321 | Chronic post-traumatic headache, intractable | ccmrtm | not risk adjusted |
| G44.329 | Chronic post-traumatic headache, not intractable | ccmrtm | not risk adjusted |
| G44.40 | Drug-induced headache, not elsewhere classified, not intractable | ccmrtm | not risk adjusted |
| G44.41 | Drug-induced headache, not elsewhere classified, intractable | ccmrtm | not risk adjusted |
| G44.51 | Hemicrania continua | ccmrtm | not risk adjusted |
| G44.52 | New daily persistent headache (NDPH) | ccmrtm | not risk adjusted |
| G44.53 | Primary thunderclap headache | ccmrtm | not risk adjusted |
| G44.59 | Other complicated headache syndrome | ccmrtm | not risk adjusted |
| G44.81 | Hypnic headache | ccmrtm | not risk adjusted |
| G44.82 | Headache associated with sexual activity | ccmrtm | not risk adjusted |
| G44.83 | Primary cough headache | ccmrtm | not risk adjusted |
| G44.84 | Primary exertional headache | ccmrtm | not risk adjusted |
| G44.85 | Primary stabbing headache | ccmrtm | not risk adjusted |
| G44.86 | Cervicogenic headache | ccmrtm | not risk adjusted |
| G44.89 | Other headache syndrome | ccmrtm | not risk adjusted |
Traumatic brain injury sequelae
F06, F07, G93.1, G93.424 codes in familyccmbhipcmCognitive and behavioural follow-up with structured instruments.
Traumatic brain injury sequelae
F06, F07, G93.1, G93.424 codes in familyccmbhipcmCMS other chronic or potentially disabling condition · CCW category: Traumatic Brain Injury and Nonpsychotic Mental Disorders due to Brain Damage · Devices: Patient-reported outcome app (RTM)
This family runs to 24 codes that differ mainly by anatomic site and laterality, which does not change whether the condition supports care management. The codes are not listed one by one here. Code to the site and side documented in the record, within F06, F07, G93.1, G93.4.
Musculoskeletal and pain
Chronic pain and fibromyalgia
M79.7, G89.2, G89.4, R52, G93.310 codesrtmccmbhiPain scores, sleep and function, with behavioural support where indicated.
Chronic pain and fibromyalgia
M79.7, G89.2, G89.4, R52, G93.310 codesrtmccmbhiCMS other chronic or potentially disabling condition · CCW category: Fibromyalgia, Chronic Pain and Fatigue · Devices: Patient-reported outcome app (RTM)
G89.4 (chronic pain syndrome) and G89.29 (other chronic pain) are secondary codes. Code the underlying condition alongside.
| Code | Official ICD-10-CM description | Programs | Risk adjustment |
|---|---|---|---|
| G89.21 | Chronic pain due to trauma | rtmccmbhi | not risk adjusted |
| G89.22 | Chronic post-thoracotomy pain | rtmccmbhi | not risk adjusted |
| G89.28 | Other chronic postprocedural pain | rtmccmbhi | not risk adjusted |
| G89.29 | Other chronic pain | rtmccmbhi | not risk adjusted |
| G89.4 | Chronic pain syndrome | rtmccmbhi | not risk adjusted |
| G93.31 | Postviral fatigue syndrome | rtmccmbhi | not risk adjusted |
| G93.32 | Myalgic encephalomyelitis/chronic fatigue syndrome | rtmccmbhi | not risk adjusted |
| G93.39 | Other post infection and related fatigue syndromes | rtmccmbhi | not risk adjusted |
| M79.7 | Fibromyalgia | rtmccmbhi | not risk adjusted |
| R52 | Pain, unspecified | rtmccmbhi | not risk adjusted |
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Clinical Context
Why behavioral health practices benefit from CCM.
Behavioral Health practices can leverage CCM to improve patient outcomes through structured care management, generating $97–$220+ per patient per month in Medicare reimbursement while reducing avoidable hospitalizations.
Related Conditions
Condition monitoring guides.
FAQ
Common questions.
01
What ICD-10 codes qualify behavioral health patients for CCM?
CMS publishes no list of codes that qualify a patient for CCM: eligibility turns on the condition and on documented medical necessity. For behavioral health, 520 billable ICD-10-CM codes cover the conditions CCM manages, spanning 17 conditions including depressive disorders, bipolar and related disorders, anxiety and fear-related disorders, trauma and stressor-related disorders, schizophrenia and other psychotic disorders, feeding and eating disorders.
02
How does CCN Health support behavioral health practices with CCM?
CCN Health provides turnkey CCM services for behavioral health practices, including patient eligibility identification, enrollment documentation, device provisioning, clinical monitoring, and full Medicare billing support.
03
What is the revenue potential for CCM in behavioral health?
Reimbursement varies by locality and payer contract, so see the CCM billing guide for current figures. Behavioral Health practices with a high prevalence of these conditions generally see the most benefit, particularly when CCM is combined with RPM and BHI for patients whose needs are distinct enough to document separately.
Sources & Compliance
Code set. Every code on this page is drawn from the official ICD-10-CM ICD-10-CM FY2026 (valid 2025-10-01 through 2026-09-30) released by CDC/NCHS, and only codes flagged valid for submission are listed. ICD-10-CM is published by the federal government and is in the public domain, so the descriptions here are the official long descriptors reproduced verbatim rather than summarized. The next code set, ICD-10-CM FY2027 (valid from 2026-10-01), is already reflected in the change flags.
Eligibility is not a code list. CMS does not publish a list of ICD-10 codes that qualify a patient for RPM, CCM, PCM, BHI, or RTM. Eligibility turns on the condition and on documented medical necessity. The programs shown against each condition are CCN Health’s clinical assessment of which programs that condition can support, not a statement of CMS approval.
Risk adjustment. HCC labels and category assignments come from the CMS-HCC V28 model for the 2026 payment year. Risk adjustment depends on the full encounter record, not on a single code, and the flags here are a prompt to check specificity rather than a payment guarantee.
CPT® notice. CPT is a registered trademark of the American Medical Association. CPT codes, descriptions, and other data only are copyright 2026 American Medical Association. All rights reserved. CPT is provided “as is” without warranty of any kind.
Sources. ICD-10-CM files, CDC/NCHS (cdc.gov); CMS Chronic Conditions Data Warehouse condition categories (ccwdata.org); CMS-HCC risk adjustment model software and ICD-10 mappings (cms.gov); AHRQ Clinical Classifications Software Refined (ahrq.gov).
Disclaimer. This page is informational and does not constitute billing, clinical, or legal advice. Diagnosis coding must reflect the documentation in the medical record. Verify all codes against the official CMS and CDC/NCHS publications and your contracted payer agreements before billing.