CCM · Geriatrics

CCM Qualifying Diagnoses
for Geriatrics.

753 ICD-10-CM codes cover geriatrics patients for Chronic Care Management (CCM).

Qualifying Codes

ICD-10 codes for geriatrics.

Cardiovascular

Essential hypertension

I101 codesrpmccmpcm

Home blood pressure readings, typically twice daily, reviewed against a target set in the care plan.

CMS chronic condition · CCW category: Hypertension · Devices: Blood pressure cuff

Code	Official ICD-10-CM description	Programs	Risk adjustment
I10	Essential (primary) hypertension	rpmccmpcm	not risk adjusted

Heart failure

I5023 codesrpmccmpcm

Daily weight is the primary signal, since a two to three pound overnight gain precedes decompensation. Blood pressure and pulse oximetry support diuretic titration.

CMS chronic condition · CCW category: Heart Failure and Non-Ischemic Heart Disease · Devices: Connected weight scale, Blood pressure cuff, Pulse oximeter

Read the heart failure monitoring guide

Code	Official ICD-10-CM description	Programs	Risk adjustment
I50.1	Left ventricular failure, unspecified	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.20	Unspecified systolic (congestive) heart failure	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.21	Acute systolic (congestive) heart failure	rpmccmpcm	HCC 225 · Acute Heart Failure (Excludes Acute on Chronic)
I50.22	Chronic systolic (congestive) heart failure	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.23	Acute on chronic systolic (congestive) heart failure	rpmccmpcm	HCC 224 · Acute on Chronic Heart Failure
I50.30	Unspecified diastolic (congestive) heart failure	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.31	Acute diastolic (congestive) heart failure	rpmccmpcm	HCC 225 · Acute Heart Failure (Excludes Acute on Chronic)
I50.32	Chronic diastolic (congestive) heart failure	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.33	Acute on chronic diastolic (congestive) heart failure	rpmccmpcm	HCC 224 · Acute on Chronic Heart Failure
I50.40	Unspecified combined systolic (congestive) and diastolic (congestive) heart failure	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.41	Acute combined systolic (congestive) and diastolic (congestive) heart failure	rpmccmpcm	HCC 225 · Acute Heart Failure (Excludes Acute on Chronic)
I50.42	Chronic combined systolic (congestive) and diastolic (congestive) heart failure	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.43	Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure	rpmccmpcm	HCC 224 · Acute on Chronic Heart Failure
I50.810	Right heart failure, unspecified	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.811	Acute right heart failure	rpmccmpcm	HCC 225 · Acute Heart Failure (Excludes Acute on Chronic)
I50.812	Chronic right heart failure	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.813	Acute on chronic right heart failure	rpmccmpcm	HCC 225 · Acute Heart Failure (Excludes Acute on Chronic)
I50.814	Right heart failure due to left heart failure	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.82	Biventricular heart failure	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.83	High output heart failure	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.84	End stage heart failure	rpmccmpcm	HCC 222 · End-Stage Heart Failure
I50.89	Other heart failure	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute
I50.9	Heart failure, unspecified	rpmccmpcm	HCC 226 · Heart Failure, Except End-Stage and Acute

Atrial fibrillation and flutter

I489 codesrpmccmpcm

Rate and rhythm capture plus blood pressure, most often during rate-control or anticoagulation management.

CMS chronic condition · CCW category: Atrial Fibrillation and Flutter · Devices: Single-lead ECG, Blood pressure cuff

I48.1 and I48.2 are no longer valid on their own. Code to I48.11, I48.19, I48.20 or I48.21.

Read the atrial fibrillation and flutter monitoring guide

Code	Official ICD-10-CM description	Programs	Risk adjustment
I48.0	Paroxysmal atrial fibrillation	rpmccmpcm	HCC 238 · Specified Heart Arrhythmias
I48.11	Longstanding persistent atrial fibrillation	rpmccmpcm	HCC 238 · Specified Heart Arrhythmias
I48.19	Other persistent atrial fibrillation	rpmccmpcm	HCC 238 · Specified Heart Arrhythmias
I48.20	Chronic atrial fibrillation, unspecified	rpmccmpcm	HCC 238 · Specified Heart Arrhythmias
I48.21	Permanent atrial fibrillation	rpmccmpcm	HCC 238 · Specified Heart Arrhythmias
I48.3	Typical atrial flutter	rpmccmpcm	HCC 238 · Specified Heart Arrhythmias
I48.4	Atypical atrial flutter	rpmccmpcm	HCC 238 · Specified Heart Arrhythmias
I48.91	Unspecified atrial fibrillation	rpmccmpcm	HCC 238 · Specified Heart Arrhythmias
I48.92	Unspecified atrial flutter	rpmccmpcm	HCC 238 · Specified Heart Arrhythmias

Ischemic heart disease

I20, I24, I2567 codesrpmccmpcm

Blood pressure and heart rate against anti-anginal and secondary-prevention targets.

CMS chronic condition · CCW category: Ischemic Heart Disease · Devices: Blood pressure cuff, Single-lead ECG

Code	Official ICD-10-CM description	Programs	Risk adjustment
I20.0	Unstable angina	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I20.1	Angina pectoris with documented spasm	rpmccmpcm	not risk adjusted
I20.2	Refractory angina pectoris	rpmccmpcm	not risk adjusted
I20.81	Angina pectoris with coronary microvascular dysfunction	rpmccmpcm	not risk adjusted
I20.89	Other forms of angina pectoris	rpmccmpcm	not risk adjusted
I20.9	Angina pectoris, unspecifiedlow specificity	rpmccmpcm	not risk adjusted
I24.0	Acute coronary thrombosis not resulting in myocardial infarction	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I24.1	Dressler's syndrome	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I24.81	Acute coronary microvascular dysfunction	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I24.89	Other forms of acute ischemic heart disease	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I24.9	Acute ischemic heart disease, unspecified	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I25.10	Atherosclerotic heart disease of native coronary artery without angina pectoris	rpmccmpcm	not risk adjusted
I25.110	Atherosclerotic heart disease of native coronary artery with unstable angina pectoris	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I25.111	Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm	rpmccmpcm	not risk adjusted
I25.112	Atherosclerotic heart disease of native coronary artery with refractory angina pectoris	rpmccmpcm	not risk adjusted
I25.118	Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris	rpmccmpcm	not risk adjusted
I25.119	Atherosclerotic heart disease of native coronary artery with unspecified angina pectorislow specificity	rpmccmpcm	not risk adjusted
I25.2	Old myocardial infarction	rpmccmpcm	not risk adjusted
I25.3	Aneurysm of heart	rpmccmpcm	not risk adjusted
I25.41	Coronary artery aneurysm	rpmccmpcm	not risk adjusted
I25.42	Coronary artery dissection	rpmccmpcm	not risk adjusted
I25.5	Ischemic cardiomyopathy	rpmccmpcm	not risk adjusted
I25.6	Silent myocardial ischemia	rpmccmpcm	not risk adjusted
I25.700	Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I25.701	Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasmlow specificity	rpmccmpcm	not risk adjusted
I25.702	Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectorislow specificity	rpmccmpcm	not risk adjusted
I25.708	Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectorislow specificity	rpmccmpcm	not risk adjusted
I25.709	Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectorislow specificity	rpmccmpcm	not risk adjusted
I25.710	Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I25.711	Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm	rpmccmpcm	not risk adjusted
I25.712	Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris	rpmccmpcm	not risk adjusted
I25.718	Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris	rpmccmpcm	not risk adjusted
I25.719	Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectorislow specificity	rpmccmpcm	not risk adjusted
I25.720	Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I25.721	Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm	rpmccmpcm	not risk adjusted
I25.722	Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris	rpmccmpcm	not risk adjusted
I25.728	Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris	rpmccmpcm	not risk adjusted
I25.729	Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectorislow specificity	rpmccmpcm	not risk adjusted
I25.730	Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I25.731	Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm	rpmccmpcm	not risk adjusted
I25.732	Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris	rpmccmpcm	not risk adjusted
I25.738	Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris	rpmccmpcm	not risk adjusted
I25.739	Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectorislow specificity	rpmccmpcm	not risk adjusted
I25.750	Atherosclerosis of native coronary artery of transplanted heart with unstable angina	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I25.751	Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm	rpmccmpcm	not risk adjusted
I25.752	Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris	rpmccmpcm	not risk adjusted
I25.758	Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris	rpmccmpcm	not risk adjusted
I25.759	Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectorislow specificity	rpmccmpcm	not risk adjusted
I25.760	Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I25.761	Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm	rpmccmpcm	not risk adjusted
I25.762	Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris	rpmccmpcm	not risk adjusted
I25.768	Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris	rpmccmpcm	not risk adjusted
I25.769	Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectorislow specificity	rpmccmpcm	not risk adjusted
I25.790	Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris	rpmccmpcm	HCC 229 · Unstable Angina and Other Acute Ischemic Heart Disease
I25.791	Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm	rpmccmpcm	not risk adjusted
I25.792	Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris	rpmccmpcm	not risk adjusted
I25.798	Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris	rpmccmpcm	not risk adjusted
I25.799	Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectorislow specificity	rpmccmpcm	not risk adjusted
I25.810	Atherosclerosis of coronary artery bypass graft(s) without angina pectoris	rpmccmpcm	not risk adjusted
I25.811	Atherosclerosis of native coronary artery of transplanted heart without angina pectoris	rpmccmpcm	not risk adjusted
I25.812	Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris	rpmccmpcm	not risk adjusted
I25.82	Chronic total occlusion of coronary artery	rpmccmpcm	not risk adjusted
I25.83	Coronary atherosclerosis due to lipid rich plaque	rpmccmpcm	not risk adjusted
I25.84	Coronary atherosclerosis due to calcified coronary lesion	rpmccmpcm	not risk adjusted
I25.85	Chronic coronary microvascular dysfunction	rpmccmpcm	not risk adjusted
I25.89	Other forms of chronic ischemic heart disease	rpmccmpcm	not risk adjusted
I25.9	Chronic ischemic heart disease, unspecifiedlow specificity	rpmccmpcm	not risk adjusted

Stroke, TIA and cerebrovascular sequelae

G45, G46, I63.9, I65, I66, I67, I69.3, I69.9140 codes in familyrpmccmpcm

Blood pressure control is the dominant secondary-prevention lever. Activity and fall sensing supports the deficits captured by the I69 sequela codes.

CMS chronic condition · CCW category: Stroke/Transient Ischemic Attack · Devices: Blood pressure cuff, Contactless activity and fall radar

I69 codes carry the deficit, so they are usually the ones that justify ongoing care management rather than the acute I63 code.

This family runs to 140 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 G45, G46, I63.9, I65, I66, I67, I69.3, I69.9.

Peripheral and visceral vascular disease

I70, I71, I72, I73, I77, I79318 codes in familyrpmccmpcm

Blood pressure and peripheral perfusion, often alongside diabetic foot surveillance.

CMS other chronic or potentially disabling condition · CCW category: Peripheral Vascular Disease (PVD) · Devices: Blood pressure cuff, Pulse oximeter

This family runs to 318 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 I70, I71, I72, I73, I77, I79.

Heart valve disorders

I05, I06, I07, I08, I34, I35, I36, I3742 codesrpmccm

Blood pressure and weight surveillance between echocardiograms.

Added by CCN Health · Devices: Blood pressure cuff, Connected weight scale

Code	Official ICD-10-CM description	Programs	Risk adjustment
I05.0	Rheumatic mitral stenosis	rpmccm	not risk adjusted
I05.1	Rheumatic mitral insufficiency	rpmccm	not risk adjusted
I05.2	Rheumatic mitral stenosis with insufficiency	rpmccm	not risk adjusted
I05.8	Other rheumatic mitral valve diseases	rpmccm	not risk adjusted
I05.9	Rheumatic mitral valve disease, unspecified	rpmccm	not risk adjusted
I06.0	Rheumatic aortic stenosis	rpmccm	not risk adjusted
I06.1	Rheumatic aortic insufficiency	rpmccm	not risk adjusted
I06.2	Rheumatic aortic stenosis with insufficiency	rpmccm	not risk adjusted
I06.8	Other rheumatic aortic valve diseases	rpmccm	not risk adjusted
I06.9	Rheumatic aortic valve disease, unspecified	rpmccm	not risk adjusted
I07.0	Rheumatic tricuspid stenosis	rpmccm	not risk adjusted
I07.1	Rheumatic tricuspid insufficiency	rpmccm	not risk adjusted
I07.2	Rheumatic tricuspid stenosis and insufficiency	rpmccm	not risk adjusted
I07.8	Other rheumatic tricuspid valve diseases	rpmccm	not risk adjusted
I07.9	Rheumatic tricuspid valve disease, unspecified	rpmccm	not risk adjusted
I08.0	Rheumatic disorders of both mitral and aortic valves	rpmccm	not risk adjusted
I08.1	Rheumatic disorders of both mitral and tricuspid valves	rpmccm	not risk adjusted
I08.2	Rheumatic disorders of both aortic and tricuspid valves	rpmccm	not risk adjusted
I08.3	Combined rheumatic disorders of mitral, aortic and tricuspid valves	rpmccm	not risk adjusted
I08.8	Other rheumatic multiple valve diseases	rpmccm	not risk adjusted
I08.9	Rheumatic multiple valve disease, unspecified	rpmccm	not risk adjusted
I34.0	Nonrheumatic mitral (valve) insufficiency	rpmccm	not risk adjusted
I34.1	Nonrheumatic mitral (valve) prolapse	rpmccm	not risk adjusted
I34.2	Nonrheumatic mitral (valve) stenosis	rpmccm	not risk adjusted
I34.81	Nonrheumatic mitral (valve) annulus calcification	rpmccm	not risk adjusted
I34.89	Other nonrheumatic mitral valve disorders	rpmccm	not risk adjusted
I34.9	Nonrheumatic mitral valve disorder, unspecified	rpmccm	not risk adjusted
I35.0	Nonrheumatic aortic (valve) stenosis	rpmccm	not risk adjusted
I35.1	Nonrheumatic aortic (valve) insufficiency	rpmccm	not risk adjusted
I35.2	Nonrheumatic aortic (valve) stenosis with insufficiency	rpmccm	not risk adjusted
I35.8	Other nonrheumatic aortic valve disorders	rpmccm	not risk adjusted
I35.9	Nonrheumatic aortic valve disorder, unspecified	rpmccm	not risk adjusted
I36.0	Nonrheumatic tricuspid (valve) stenosis	rpmccm	not risk adjusted
I36.1	Nonrheumatic tricuspid (valve) insufficiency	rpmccm	not risk adjusted
I36.2	Nonrheumatic tricuspid (valve) stenosis with insufficiency	rpmccm	not risk adjusted
I36.8	Other nonrheumatic tricuspid valve disorders	rpmccm	not risk adjusted
I36.9	Nonrheumatic tricuspid valve disorder, unspecified	rpmccm	not risk adjusted
I37.0	Nonrheumatic pulmonary valve stenosis	rpmccm	not risk adjusted
I37.1	Nonrheumatic pulmonary valve insufficiency	rpmccm	not risk adjusted
I37.2	Nonrheumatic pulmonary valve stenosis with insufficiency	rpmccm	not risk adjusted
I37.8	Other nonrheumatic pulmonary valve disorders	rpmccm	not risk adjusted
I37.9	Nonrheumatic pulmonary valve disorder, unspecified	rpmccm	not risk adjusted

Endocrine and metabolic

Type 2 diabetes mellitus

E1187 codesrpmccmpcm

Blood glucose by meter or CGM, commonly paired with blood pressure and weight because the comorbidities travel together.

CMS chronic condition · CCW category: Diabetes · Devices: Blood glucose meter, Continuous glucose monitor, Blood pressure cuff, Connected weight scale

Code to the complication. E11.9 (without complications) is accurate only when the record truly documents none, and it carries no HCC weight.

Read the type 2 diabetes mellitus monitoring guide

Code	Official ICD-10-CM description	Programs	Risk adjustment
E11.00	Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)	rpmccmpcm	HCC 36 · Diabetes with Severe Acute Complications
E11.01	Type 2 diabetes mellitus with hyperosmolarity with coma	rpmccmpcm	HCC 36 · Diabetes with Severe Acute Complications
E11.10	Type 2 diabetes mellitus with ketoacidosis without coma	rpmccmpcm	HCC 36 · Diabetes with Severe Acute Complications
E11.11	Type 2 diabetes mellitus with ketoacidosis with coma	rpmccmpcm	HCC 36 · Diabetes with Severe Acute Complications
E11.21	Type 2 diabetes mellitus with diabetic nephropathy	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.22	Type 2 diabetes mellitus with diabetic chronic kidney disease	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.29	Type 2 diabetes mellitus with other diabetic kidney complication	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.311	Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.319	Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3211	Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3212	Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3213	Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3219	Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3291	Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3292	Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3293	Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3299	Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3311	Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3312	Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3313	Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3319	Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3391	Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3392	Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3393	Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3399	Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3411	Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3412	Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3413	Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3419	Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3491	Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3492	Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3493	Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3499	Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3511	Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3512	Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3513	Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3519	Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3521	Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3522	Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3523	Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3529	Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3531	Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3532	Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3533	Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3539	Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3541	Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3542	Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3543	Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3549	Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3551	Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3552	Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3553	Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3559	Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3591	Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3592	Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3593	Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.3599	Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.36	Type 2 diabetes mellitus with diabetic cataract	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.37X1	Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.37X2	Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.37X3	Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.37X9	Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.39	Type 2 diabetes mellitus with other diabetic ophthalmic complication	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.40	Type 2 diabetes mellitus with diabetic neuropathy, unspecified	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.41	Type 2 diabetes mellitus with diabetic mononeuropathy	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.42	Type 2 diabetes mellitus with diabetic polyneuropathy	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.43	Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.44	Type 2 diabetes mellitus with diabetic amyotrophy	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.49	Type 2 diabetes mellitus with other diabetic neurological complication	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.51	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.52	Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.59	Type 2 diabetes mellitus with other circulatory complications	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.610	Type 2 diabetes mellitus with diabetic neuropathic arthropathy	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.618	Type 2 diabetes mellitus with other diabetic arthropathy	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.620	Type 2 diabetes mellitus with diabetic dermatitis	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.621	Type 2 diabetes mellitus with foot ulcer	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.622	Type 2 diabetes mellitus with other skin ulcer	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.628	Type 2 diabetes mellitus with other skin complications	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.630	Type 2 diabetes mellitus with periodontal disease	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.638	Type 2 diabetes mellitus with other oral complications	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.641	Type 2 diabetes mellitus with hypoglycemia with coma	rpmccmpcm	HCC 36 · Diabetes with Severe Acute Complications
E11.649	Type 2 diabetes mellitus with hypoglycemia without coma	rpmccmpcm	HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications
E11.65	Type 2 diabetes mellitus with hyperglycemia	rpmccmpcm	HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications
E11.69	Type 2 diabetes mellitus with other specified complication	rpmccmpcm	HCC 37 · Diabetes with Chronic Complications
E11.8	Type 2 diabetes mellitus with unspecified complications	rpmccmpcm	HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications
E11.9	Type 2 diabetes mellitus without complications	rpmccmpcm	HCC 38 · Diabetes with Glycemic, Unspecified, or No Complications
E11.A	Type 2 diabetes mellitus without complications in remission	rpmccmpcm	not risk adjusted

Obesity

E66, Z68.3, Z68.425 codesrpmccm

Weight trend against a documented target, usually alongside blood pressure or glucose.

CMS other chronic or potentially disabling condition · CCW category: Obesity · Devices: Connected weight scale, Blood pressure cuff

Z68 BMI codes are secondary codes. They never stand alone: code the obesity or the underlying condition first.

Effective 2026-10-01: Z68.1 gains finer detail at the low end on 2026-10-01 with Z68.18 (BMI 18.4 or less) and Z68.19 (BMI 18.5 to 19.9).

Read the obesity monitoring guide

Code	Official ICD-10-CM description	Programs	Risk adjustment
E66.01	Morbid (severe) obesity due to excess calories	rpmccm	HCC 48 · Morbid Obesity
E66.09	Other obesity due to excess calories	rpmccm	not risk adjusted
E66.1	Drug-induced obesity	rpmccm	not risk adjusted
E66.2	Morbid (severe) obesity with alveolar hypoventilation	rpmccm	HCC 48 · Morbid Obesity
E66.3	Overweight	rpmccm	not risk adjusted
E66.811	Obesity, class 1	rpmccm	not risk adjusted
E66.812	Obesity, class 2	rpmccm	not risk adjusted
E66.813	Obesity, class 3	rpmccm	HCC 48 · Morbid Obesity
E66.89	Other obesity not elsewhere classified	rpmccm	not risk adjusted
E66.9	Obesity, unspecifiedlow specificity	rpmccm	not risk adjusted
Z68.30	Body mass index [BMI] 30.0-30.9, adult	rpmccm	not risk adjusted
Z68.31	Body mass index [BMI] 31.0-31.9, adult	rpmccm	not risk adjusted
Z68.32	Body mass index [BMI] 32.0-32.9, adult	rpmccm	not risk adjusted
Z68.33	Body mass index [BMI] 33.0-33.9, adult	rpmccm	not risk adjusted
Z68.34	Body mass index [BMI] 34.0-34.9, adult	rpmccm	not risk adjusted
Z68.35	Body mass index [BMI] 35.0-35.9, adult	rpmccm	not risk adjusted
Z68.36	Body mass index [BMI] 36.0-36.9, adult	rpmccm	not risk adjusted
Z68.37	Body mass index [BMI] 37.0-37.9, adult	rpmccm	not risk adjusted
Z68.38	Body mass index [BMI] 38.0-38.9, adult	rpmccm	not risk adjusted
Z68.39	Body mass index [BMI] 39.0-39.9, adult	rpmccm	not risk adjusted
Z68.41	Body mass index [BMI] 40.0-44.9, adult	rpmccm	HCC 48 · Morbid Obesity
Z68.42	Body mass index [BMI] 45.0-49.9, adult	rpmccm	HCC 48 · Morbid Obesity
Z68.43	Body mass index [BMI] 50.0-59.9, adult	rpmccm	HCC 48 · Morbid Obesity
Z68.44	Body mass index [BMI] 60.0-69.9, adult	rpmccm	HCC 48 · Morbid Obesity
Z68.45	Body mass index [BMI] 70 or greater, adult	rpmccm	HCC 48 · Morbid Obesity

Respiratory

COPD, emphysema and bronchiectasis

J40, J41, J42, J43, J44, J4718 codesrpmccmpcmrtm

Oxygen saturation is the primary signal, with symptom scores and inhaler adherence supporting RTM.

CMS chronic condition · CCW category: Chronic Obstructive Pulmonary Disease · Devices: Pulse oximeter, Spirometer or peak flow meter

Read the copd, emphysema and bronchiectasis monitoring guide

Code	Official ICD-10-CM description	Programs	Risk adjustment
J40	Bronchitis, not specified as acute or chronic	rpmccmpcmrtm	not risk adjusted
J41.0	Simple chronic bronchitis	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J41.1	Mucopurulent chronic bronchitis	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J41.8	Mixed simple and mucopurulent chronic bronchitis	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J42	Unspecified chronic bronchitis	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J43.0	Unilateral pulmonary emphysema [MacLeod's syndrome]	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J43.1	Panlobular emphysema	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J43.2	Centrilobular emphysema	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J43.8	Other emphysema	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J43.9	Emphysema, unspecified	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J44.0	Chronic obstructive pulmonary disease with (acute) lower respiratory infection	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J44.1	Chronic obstructive pulmonary disease with (acute) exacerbation	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J44.81	Bronchiolitis obliterans and bronchiolitis obliterans syndrome	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J44.89	Other specified chronic obstructive pulmonary disease	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J44.9	Chronic obstructive pulmonary disease, unspecified	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J47.0	Bronchiectasis with acute lower respiratory infection	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J47.1	Bronchiectasis with (acute) exacerbation	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders
J47.9	Bronchiectasis, uncomplicated	rpmccmpcmrtm	HCC 280 · Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders

Respiratory failure and oxygen dependence

J96, J98.4, Z99.11, Z99.12, Z99.8116 codesrpmccmpcm

Continuous or scheduled oxygen saturation with alerting thresholds.

Added by CCN Health · Devices: Pulse oximeter

Z99.81 (dependence on supplemental oxygen) is a secondary code that supports medical necessity. It never stands alone.

Code	Official ICD-10-CM description	Programs	Risk adjustment
J96.00	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J96.01	Acute respiratory failure with hypoxia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J96.02	Acute respiratory failure with hypercapnia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J96.10	Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J96.11	Chronic respiratory failure with hypoxia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J96.12	Chronic respiratory failure with hypercapnia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J96.20	Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J96.21	Acute and chronic respiratory failure with hypoxia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J96.22	Acute and chronic respiratory failure with hypercapnia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J96.90	Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J96.91	Respiratory failure, unspecified with hypoxia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J96.92	Respiratory failure, unspecified with hypercapnia	rpmccmpcm	HCC 213 · Cardio-Respiratory Failure and Shock
J98.4	Other disorders of lung	rpmccmpcm	not risk adjusted
Z99.11	Dependence on respirator [ventilator] status	rpmccmpcm	HCC 211 · Respirator Dependence/Tracheostomy Status/Complications
Z99.12	Encounter for respirator [ventilator] dependence during power failure	rpmccmpcm	HCC 211 · Respirator Dependence/Tracheostomy Status/Complications
Z99.81	Dependence on supplemental oxygen	rpmccmpcm	not risk adjusted

Sleep apnea and sleep-wake disorders

G4743 codesrpmccm

Overnight oxygen saturation and respiration, plus PAP adherence where the device reports it.

Added by CCN Health · Devices: Sleep and respiration monitor, Pulse oximeter

Not a CCW category, but sleep apnea is one of the most common comorbidities enrolled alongside hypertension, heart failure and obesity.

Code	Official ICD-10-CM description	Programs	Risk adjustment
G47.00	Insomnia, unspecified	rpmccm	not risk adjusted
G47.01	Insomnia due to medical condition	rpmccm	not risk adjusted
G47.09	Other insomnia	rpmccm	not risk adjusted
G47.10	Hypersomnia, unspecified	rpmccm	not risk adjusted
G47.11	Idiopathic hypersomnia with long sleep time	rpmccm	not risk adjusted
G47.12	Idiopathic hypersomnia without long sleep time	rpmccm	not risk adjusted
G47.13	Recurrent hypersomnia	rpmccm	not risk adjusted
G47.14	Hypersomnia due to medical condition	rpmccm	not risk adjusted
G47.19	Other hypersomnia	rpmccm	not risk adjusted
G47.20	Circadian rhythm sleep disorder, unspecified type	rpmccm	not risk adjusted
G47.21	Circadian rhythm sleep disorder, delayed sleep phase type	rpmccm	not risk adjusted
G47.22	Circadian rhythm sleep disorder, advanced sleep phase type	rpmccm	not risk adjusted
G47.23	Circadian rhythm sleep disorder, irregular sleep wake type	rpmccm	not risk adjusted
G47.24	Circadian rhythm sleep disorder, free running type	rpmccm	not risk adjusted
G47.25	Circadian rhythm sleep disorder, jet lag type	rpmccm	not risk adjusted
G47.26	Circadian rhythm sleep disorder, shift work type	rpmccm	not risk adjusted
G47.27	Circadian rhythm sleep disorder in conditions classified elsewhere	rpmccm	not risk adjusted
G47.29	Other circadian rhythm sleep disorder	rpmccm	not risk adjusted
G47.30	Sleep apnea, unspecified	rpmccm	not risk adjusted
G47.31	Primary central sleep apnea	rpmccm	not risk adjusted
G47.32	High altitude periodic breathing	rpmccm	not risk adjusted
G47.33	Obstructive sleep apnea (adult) (pediatric)	rpmccm	not risk adjusted
G47.34	Idiopathic sleep related nonobstructive alveolar hypoventilation	rpmccm	not risk adjusted
G47.35	Congenital central alveolar hypoventilation syndrome	rpmccm	not risk adjusted
G47.36	Sleep related hypoventilation in conditions classified elsewhere	rpmccm	not risk adjusted
G47.37	Central sleep apnea in conditions classified elsewhere	rpmccm	not risk adjusted
G47.39	Other sleep apnea	rpmccm	not risk adjusted
G47.411	Narcolepsy with cataplexy	rpmccm	not risk adjusted
G47.419	Narcolepsy without cataplexy	rpmccm	not risk adjusted
G47.421	Narcolepsy in conditions classified elsewhere with cataplexy	rpmccm	not risk adjusted
G47.429	Narcolepsy in conditions classified elsewhere without cataplexy	rpmccm	not risk adjusted
G47.50	Parasomnia, unspecified	rpmccm	not risk adjusted
G47.51	Confusional arousals	rpmccm	not risk adjusted
G47.52	REM sleep behavior disorder	rpmccm	not risk adjusted
G47.53	Recurrent isolated sleep paralysis	rpmccm	not risk adjusted
G47.54	Parasomnia in conditions classified elsewhere	rpmccm	not risk adjusted
G47.59	Other parasomnia	rpmccm	not risk adjusted
G47.61	Periodic limb movement disorder	rpmccm	not risk adjusted
G47.62	Sleep related leg cramps	rpmccm	not risk adjusted
G47.63	Sleep related bruxism	rpmccm	not risk adjusted
G47.69	Other sleep related movement disorders	rpmccm	not risk adjusted
G47.8	Other sleep disorders	rpmccm	not risk adjusted
G47.9	Sleep disorder, unspecified	rpmccm	not risk adjusted

Kidney and urologic

Chronic kidney disease and ESRD

N18, N19, Z99.2, Z94.012 codesrpmccmpcm

Blood pressure and weight for volume management. Weight change between dialysis sessions is the practical signal in late-stage disease.

CMS chronic condition · CCW category: Chronic Kidney Disease · Devices: Blood pressure cuff, Connected weight scale

Stage the disease. N18.9 (unspecified) carries no HCC weight and invites review, while N18.30 through N18.6 do.

Read the chronic kidney disease and esrd monitoring guide

Code	Official ICD-10-CM description	Programs	Risk adjustment
N18.1	Chronic kidney disease, stage 1	rpmccmpcm	not risk adjusted
N18.2	Chronic kidney disease, stage 2 (mild)	rpmccmpcm	not risk adjusted
N18.30	Chronic kidney disease, stage 3 unspecified	rpmccmpcm	HCC 329 · Chronic Kidney Disease, Moderate (Stage 3, Except 3B)
N18.31	Chronic kidney disease, stage 3a	rpmccmpcm	HCC 329 · Chronic Kidney Disease, Moderate (Stage 3, Except 3B)
N18.32	Chronic kidney disease, stage 3b	rpmccmpcm	HCC 328 · Chronic Kidney Disease, Moderate (Stage 3B)
N18.4	Chronic kidney disease, stage 4 (severe)	rpmccmpcm	HCC 327 · Chronic Kidney Disease, Severe (Stage 4)
N18.5	Chronic kidney disease, stage 5	rpmccmpcm	HCC 326 · Chronic Kidney Disease, Stage 5
N18.6	End stage renal disease	rpmccmpcm	HCC 326 · Chronic Kidney Disease, Stage 5
N18.9	Chronic kidney disease, unspecifiedlow specificity	rpmccmpcm	not risk adjusted
N19	Unspecified kidney failure	rpmccmpcm	not risk adjusted
Z94.0	Kidney transplant status	rpmccmpcm	not risk adjusted
Z99.2	Dependence on renal dialysis	rpmccmpcm	not risk adjusted

Benign prostatic hyperplasia

N404 codesccm

Symptom-score follow-up rather than device data.

CMS chronic condition · CCW category: Benign Prostatic Hyperplasia

Code	Official ICD-10-CM description	Programs	Risk adjustment
N40.0	Benign prostatic hyperplasia without lower urinary tract symptoms	ccm	not risk adjusted
N40.1	Benign prostatic hyperplasia with lower urinary tract symptoms	ccm	not risk adjusted
N40.2	Nodular prostate without lower urinary tract symptoms	ccm	not risk adjusted
N40.3	Nodular prostate with lower urinary tract symptoms	ccm	not risk adjusted

Behavioral health and substance use

Depressive disorders

F32, F33, F34.120 codesbhiccm

PHQ-9 at defined intervals, with the score trend recorded in the care plan.

CMS 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

Anxiety and fear-related disorders

F40, F4128 codesbhiccm

GAD-7 at defined intervals.

CMS 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

Neurologic and cognitive

Alzheimer's disease

G304 codesccmpcm

Activity, night-time movement and fall detection, with caregiver-reported change.

CMS 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 codesccmpcm

Activity and fall detection with caregiver-reported change.

CMS 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

Parkinson's disease and secondary parkinsonism

G20, G21, G23, G24, G2545 codesccmpcmrtm

Gait, activity and fall detection, with therapy adherence tracked under RTM.

CMS chronic condition · CCW category: Parkinson's Disease and Secondary Parkinsonism · Devices: Contactless activity and fall radar, Patient-reported outcome app (RTM)

G20 alone is no longer valid. Code to G20.A1, G20.A2, G20.B1, G20.B2 or G20.C.

Code	Official ICD-10-CM description	Programs	Risk adjustment
G20.A1	Parkinson's disease without dyskinesia, without mention of fluctuations	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G20.A2	Parkinson's disease without dyskinesia, with fluctuations	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G20.B1	Parkinson's disease with dyskinesia, without mention of fluctuations	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G20.B2	Parkinson's disease with dyskinesia, with fluctuations	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G20.C	Parkinsonism, unspecified	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G21.0	Malignant neuroleptic syndrome	ccmpcmrtm	not risk adjusted
G21.11	Neuroleptic induced parkinsonism	ccmpcmrtm	not risk adjusted
G21.19	Other drug induced secondary parkinsonism	ccmpcmrtm	not risk adjusted
G21.2	Secondary parkinsonism due to other external agents	ccmpcmrtm	not risk adjusted
G21.3	Postencephalitic parkinsonism	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G21.4	Vascular parkinsonism	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G21.8	Other secondary parkinsonism	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G21.9	Secondary parkinsonism, unspecified	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G23.0	Hallervorden-Spatz disease	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G23.1	Progressive supranuclear ophthalmoplegia [Steele-Richardson-Olszewski]	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G23.2	Striatonigral degeneration	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G23.3	Hypomyelination with atrophy of the basal ganglia and cerebellum	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G23.8	Other specified degenerative diseases of basal ganglia	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G23.9	Degenerative disease of basal ganglia, unspecified	ccmpcmrtm	HCC 199 · Parkinson and Other Degenerative Disease of Basal Ganglia
G24.01	Drug induced subacute dyskinesia	ccmpcmrtm	not risk adjusted
G24.02	Drug induced acute dystonia	ccmpcmrtm	not risk adjusted
G24.09	Other drug induced dystonia	ccmpcmrtm	not risk adjusted
G24.1	Genetic torsion dystonia	ccmpcmrtm	not risk adjusted
G24.2	Idiopathic nonfamilial dystonia	ccmpcmrtm	not risk adjusted
G24.3	Spasmodic torticollis	ccmpcmrtm	not risk adjusted
G24.4	Idiopathic orofacial dystonia	ccmpcmrtm	not risk adjusted
G24.5	Blepharospasm	ccmpcmrtm	not risk adjusted
G24.8	Other dystonia	ccmpcmrtm	not risk adjusted
G24.9	Dystonia, unspecified	ccmpcmrtm	not risk adjusted
G25.0	Essential tremor	ccmpcmrtm	not risk adjusted
G25.1	Drug-induced tremor	ccmpcmrtm	not risk adjusted
G25.2	Other specified forms of tremor	ccmpcmrtm	not risk adjusted
G25.3	Myoclonus	ccmpcmrtm	not risk adjusted
G25.4	Drug-induced chorea	ccmpcmrtm	not risk adjusted
G25.5	Other chorea	ccmpcmrtm	not risk adjusted
G25.61	Drug induced tics	ccmpcmrtm	not risk adjusted
G25.69	Other tics of organic origin	ccmpcmrtm	not risk adjusted
G25.70	Drug induced movement disorder, unspecified	ccmpcmrtm	not risk adjusted
G25.71	Drug induced akathisia	ccmpcmrtm	not risk adjusted
G25.79	Other drug induced movement disorders	ccmpcmrtm	not risk adjusted
G25.81	Restless legs syndrome	ccmpcmrtm	not risk adjusted
G25.82	Stiff-man syndrome	ccmpcmrtm	not risk adjusted
G25.83	Benign shuddering attacks	ccmpcmrtm	not risk adjusted
G25.89	Other specified extrapyramidal and movement disorders	ccmpcmrtm	not risk adjusted
G25.9	Extrapyramidal and movement disorder, unspecified	ccmpcmrtm	not risk adjusted

Musculoskeletal and pain

Osteoarthritis

M15, M16, M17, M18, M1998 codesrtmccm

Pain scores, range of motion and home-exercise adherence. This is the core RTM use case.

CMS chronic condition · CCW category: Rheumatoid Arthritis/Osteoarthritis · Devices: Patient-reported outcome app (RTM)

Code	Official ICD-10-CM description	Programs	Risk adjustment
M15.0	Primary generalized (osteo)arthritis	rtmccm	not risk adjusted
M15.1	Heberden's nodes (with arthropathy)	rtmccm	not risk adjusted
M15.2	Bouchard's nodes (with arthropathy)	rtmccm	not risk adjusted
M15.3	Secondary multiple arthritis	rtmccm	not risk adjusted
M15.4	Erosive (osteo)arthritis	rtmccm	not risk adjusted
M15.8	Other polyosteoarthritis	rtmccm	not risk adjusted
M15.9	Polyosteoarthritis, unspecified	rtmccm	not risk adjusted
M16.0	Bilateral primary osteoarthritis of hip	rtmccm	not risk adjusted
M16.10	Unilateral primary osteoarthritis, unspecified hip	rtmccm	not risk adjusted
M16.11	Unilateral primary osteoarthritis, right hip	rtmccm	not risk adjusted
M16.12	Unilateral primary osteoarthritis, left hip	rtmccm	not risk adjusted
M16.2	Bilateral osteoarthritis resulting from hip dysplasia	rtmccm	not risk adjusted
M16.30	Unilateral osteoarthritis resulting from hip dysplasia, unspecified hip	rtmccm	not risk adjusted
M16.31	Unilateral osteoarthritis resulting from hip dysplasia, right hip	rtmccm	not risk adjusted
M16.32	Unilateral osteoarthritis resulting from hip dysplasia, left hip	rtmccm	not risk adjusted
M16.4	Bilateral post-traumatic osteoarthritis of hip	rtmccm	not risk adjusted
M16.50	Unilateral post-traumatic osteoarthritis, unspecified hip	rtmccm	not risk adjusted
M16.51	Unilateral post-traumatic osteoarthritis, right hip	rtmccm	not risk adjusted
M16.52	Unilateral post-traumatic osteoarthritis, left hip	rtmccm	not risk adjusted
M16.6	Other bilateral secondary osteoarthritis of hip	rtmccm	not risk adjusted
M16.7	Other unilateral secondary osteoarthritis of hip	rtmccm	not risk adjusted
M16.9	Osteoarthritis of hip, unspecified	rtmccm	not risk adjusted
M17.0	Bilateral primary osteoarthritis of knee	rtmccm	not risk adjusted
M17.10	Unilateral primary osteoarthritis, unspecified knee	rtmccm	not risk adjusted
M17.11	Unilateral primary osteoarthritis, right knee	rtmccm	not risk adjusted
M17.12	Unilateral primary osteoarthritis, left knee	rtmccm	not risk adjusted
M17.2	Bilateral post-traumatic osteoarthritis of knee	rtmccm	not risk adjusted
M17.30	Unilateral post-traumatic osteoarthritis, unspecified knee	rtmccm	not risk adjusted
M17.31	Unilateral post-traumatic osteoarthritis, right knee	rtmccm	not risk adjusted
M17.32	Unilateral post-traumatic osteoarthritis, left knee	rtmccm	not risk adjusted
M17.4	Other bilateral secondary osteoarthritis of knee	rtmccm	not risk adjusted
M17.5	Other unilateral secondary osteoarthritis of knee	rtmccm	not risk adjusted
M17.9	Osteoarthritis of knee, unspecified	rtmccm	not risk adjusted
M18.0	Bilateral primary osteoarthritis of first carpometacarpal joints	rtmccm	not risk adjusted
M18.10	Unilateral primary osteoarthritis of first carpometacarpal joint, unspecified hand	rtmccm	not risk adjusted
M18.11	Unilateral primary osteoarthritis of first carpometacarpal joint, right hand	rtmccm	not risk adjusted
M18.12	Unilateral primary osteoarthritis of first carpometacarpal joint, left hand	rtmccm	not risk adjusted
M18.2	Bilateral post-traumatic osteoarthritis of first carpometacarpal joints	rtmccm	not risk adjusted
M18.30	Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, unspecified hand	rtmccm	not risk adjusted
M18.31	Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, right hand	rtmccm	not risk adjusted
M18.32	Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, left hand	rtmccm	not risk adjusted
M18.4	Other bilateral secondary osteoarthritis of first carpometacarpal joints	rtmccm	not risk adjusted
M18.50	Other unilateral secondary osteoarthritis of first carpometacarpal joint, unspecified hand	rtmccm	not risk adjusted
M18.51	Other unilateral secondary osteoarthritis of first carpometacarpal joint, right hand	rtmccm	not risk adjusted
M18.52	Other unilateral secondary osteoarthritis of first carpometacarpal joint, left hand	rtmccm	not risk adjusted
M18.9	Osteoarthritis of first carpometacarpal joint, unspecified	rtmccm	not risk adjusted
M19.011	Primary osteoarthritis, right shoulder	rtmccm	not risk adjusted
M19.012	Primary osteoarthritis, left shoulder	rtmccm	not risk adjusted
M19.019	Primary osteoarthritis, unspecified shoulder	rtmccm	not risk adjusted
M19.021	Primary osteoarthritis, right elbow	rtmccm	not risk adjusted
M19.022	Primary osteoarthritis, left elbow	rtmccm	not risk adjusted
M19.029	Primary osteoarthritis, unspecified elbow	rtmccm	not risk adjusted
M19.031	Primary osteoarthritis, right wrist	rtmccm	not risk adjusted
M19.032	Primary osteoarthritis, left wrist	rtmccm	not risk adjusted
M19.039	Primary osteoarthritis, unspecified wrist	rtmccm	not risk adjusted
M19.041	Primary osteoarthritis, right hand	rtmccm	not risk adjusted
M19.042	Primary osteoarthritis, left hand	rtmccm	not risk adjusted
M19.049	Primary osteoarthritis, unspecified hand	rtmccm	not risk adjusted
M19.071	Primary osteoarthritis, right ankle and foot	rtmccm	not risk adjusted
M19.072	Primary osteoarthritis, left ankle and foot	rtmccm	not risk adjusted
M19.079	Primary osteoarthritis, unspecified ankle and foot	rtmccm	not risk adjusted
M19.09	Primary osteoarthritis, other specified site	rtmccm	not risk adjusted
M19.111	Post-traumatic osteoarthritis, right shoulder	rtmccm	not risk adjusted
M19.112	Post-traumatic osteoarthritis, left shoulder	rtmccm	not risk adjusted
M19.119	Post-traumatic osteoarthritis, unspecified shoulder	rtmccm	not risk adjusted
M19.121	Post-traumatic osteoarthritis, right elbow	rtmccm	not risk adjusted
M19.122	Post-traumatic osteoarthritis, left elbow	rtmccm	not risk adjusted
M19.129	Post-traumatic osteoarthritis, unspecified elbow	rtmccm	not risk adjusted
M19.131	Post-traumatic osteoarthritis, right wrist	rtmccm	not risk adjusted
M19.132	Post-traumatic osteoarthritis, left wrist	rtmccm	not risk adjusted
M19.139	Post-traumatic osteoarthritis, unspecified wrist	rtmccm	not risk adjusted
M19.141	Post-traumatic osteoarthritis, right hand	rtmccm	not risk adjusted
M19.142	Post-traumatic osteoarthritis, left hand	rtmccm	not risk adjusted
M19.149	Post-traumatic osteoarthritis, unspecified hand	rtmccm	not risk adjusted
M19.171	Post-traumatic osteoarthritis, right ankle and foot	rtmccm	not risk adjusted
M19.172	Post-traumatic osteoarthritis, left ankle and foot	rtmccm	not risk adjusted
M19.179	Post-traumatic osteoarthritis, unspecified ankle and foot	rtmccm	not risk adjusted
M19.19	Post-traumatic osteoarthritis, other specified site	rtmccm	not risk adjusted
M19.211	Secondary osteoarthritis, right shoulder	rtmccm	not risk adjusted
M19.212	Secondary osteoarthritis, left shoulder	rtmccm	not risk adjusted
M19.219	Secondary osteoarthritis, unspecified shoulder	rtmccm	not risk adjusted
M19.221	Secondary osteoarthritis, right elbow	rtmccm	not risk adjusted
M19.222	Secondary osteoarthritis, left elbow	rtmccm	not risk adjusted
M19.229	Secondary osteoarthritis, unspecified elbow	rtmccm	not risk adjusted
M19.231	Secondary osteoarthritis, right wrist	rtmccm	not risk adjusted
M19.232	Secondary osteoarthritis, left wrist	rtmccm	not risk adjusted
M19.239	Secondary osteoarthritis, unspecified wrist	rtmccm	not risk adjusted
M19.241	Secondary osteoarthritis, right hand	rtmccm	not risk adjusted
M19.242	Secondary osteoarthritis, left hand	rtmccm	not risk adjusted
M19.249	Secondary osteoarthritis, unspecified hand	rtmccm	not risk adjusted
M19.271	Secondary osteoarthritis, right ankle and foot	rtmccm	not risk adjusted
M19.272	Secondary osteoarthritis, left ankle and foot	rtmccm	not risk adjusted
M19.279	Secondary osteoarthritis, unspecified ankle and foot	rtmccm	not risk adjusted
M19.29	Secondary osteoarthritis, other specified site	rtmccm	not risk adjusted
M19.90	Unspecified osteoarthritis, unspecified site	rtmccm	not risk adjusted
M19.91	Primary osteoarthritis, unspecified site	rtmccm	not risk adjusted
M19.92	Post-traumatic osteoarthritis, unspecified site	rtmccm	not risk adjusted
M19.93	Secondary osteoarthritis, unspecified site	rtmccm	not risk adjusted

Osteoporosis

M80, M81, M85496 codes in familyccmrtm

Fall risk and activity, with therapy adherence for balance and strength programmes.

CMS chronic condition · CCW category: Osteoporosis With or Without Pathological Fracture · Devices: Contactless activity and fall radar, Patient-reported outcome app (RTM)

This family runs to 496 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 M80, M81, M85.

Mobility impairment and acquired deformity

M20, M21, M24, M25, R26, Z74.0, Z99.3596 codes in familyrtmccm

Gait, activity level and fall events.

CMS other chronic or potentially disabling condition · CCW category: Mobility Impairments · Devices: Contactless activity and fall radar, Patient-reported outcome app (RTM)

This family runs to 596 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 M20, M21, M24, M25, R26, Z74.0, Z99.3.

Other chronic and potentially disabling

Anemia

D50, D51, D52, D53, D55, D56, D58, D59, D60, D61, D62, D63, D6484 codesccm

Laboratory-driven. Anemia most often appears as the second CCM condition alongside CKD or heart failure.

CMS chronic condition · CCW category: Anemia

Code	Official ICD-10-CM description	Programs	Risk adjustment
D50.0	Iron deficiency anemia secondary to blood loss (chronic)	ccm	not risk adjusted
D50.1	Sideropenic dysphagia	ccm	not risk adjusted
D50.8	Other iron deficiency anemias	ccm	not risk adjusted
D50.9	Iron deficiency anemia, unspecified	ccm	not risk adjusted
D51.0	Vitamin B12 deficiency anemia due to intrinsic factor deficiency	ccm	not risk adjusted
D51.1	Vitamin B12 deficiency anemia due to selective vitamin B12 malabsorption with proteinuria	ccm	not risk adjusted
D51.2	Transcobalamin II deficiency	ccm	not risk adjusted
D51.3	Other dietary vitamin B12 deficiency anemia	ccm	not risk adjusted
D51.8	Other vitamin B12 deficiency anemias	ccm	not risk adjusted
D51.9	Vitamin B12 deficiency anemia, unspecified	ccm	not risk adjusted
D52.0	Dietary folate deficiency anemia	ccm	not risk adjusted
D52.1	Drug-induced folate deficiency anemia	ccm	not risk adjusted
D52.8	Other folate deficiency anemias	ccm	not risk adjusted
D52.9	Folate deficiency anemia, unspecified	ccm	not risk adjusted
D53.0	Protein deficiency anemia	ccm	not risk adjusted
D53.1	Other megaloblastic anemias, not elsewhere classified	ccm	not risk adjusted
D53.2	Scorbutic anemia	ccm	not risk adjusted
D53.8	Other specified nutritional anemias	ccm	not risk adjusted
D53.9	Nutritional anemia, unspecified	ccm	not risk adjusted
D55.0	Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency	ccm	not risk adjusted
D55.1	Anemia due to other disorders of glutathione metabolism	ccm	not risk adjusted
D55.21	Anemia due to pyruvate kinase deficiency	ccm	not risk adjusted
D55.29	Anemia due to other disorders of glycolytic enzymes	ccm	not risk adjusted
D55.3	Anemia due to disorders of nucleotide metabolism	ccm	not risk adjusted
D55.8	Other anemias due to enzyme disorders	ccm	not risk adjusted
D55.9	Anemia due to enzyme disorder, unspecified	ccm	not risk adjusted
D56.0	Alpha thalassemia	ccm	not risk adjusted
D56.1	Beta thalassemia	ccm	HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
D56.2	Delta-beta thalassemia	ccm	HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
D56.3	Thalassemia minor	ccm	not risk adjusted
D56.4	Hereditary persistence of fetal hemoglobin [HPFH]	ccm	not risk adjusted
D56.5	Hemoglobin E-beta thalassemia	ccm	HCC 108 · Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
D56.8	Other thalassemias	ccm	not risk adjusted
D56.9	Thalassemia, unspecifiedlow specificity	ccm	not risk adjusted
D58.0	Hereditary spherocytosis	ccm	not risk adjusted
D58.1	Hereditary elliptocytosis	ccm	not risk adjusted
D58.2	Other hemoglobinopathies	ccm	not risk adjusted
D58.8	Other specified hereditary hemolytic anemias	ccm	not risk adjusted
D58.9	Hereditary hemolytic anemia, unspecified	ccm	not risk adjusted
D59.0	Drug-induced autoimmune hemolytic anemia	ccm	not risk adjusted
D59.10	Autoimmune hemolytic anemia, unspecified	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.11	Warm autoimmune hemolytic anemia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.12	Cold autoimmune hemolytic anemia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.13	Mixed type autoimmune hemolytic anemia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.19	Other autoimmune hemolytic anemia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.2	Drug-induced nonautoimmune hemolytic anemia	ccm	not risk adjusted
D59.30	Hemolytic-uremic syndrome, unspecified	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.31	Infection-associated hemolytic-uremic syndrome	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.32	Hereditary hemolytic-uremic syndrome	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.39	Other hemolytic-uremic syndrome	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.4	Other nonautoimmune hemolytic anemias	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.5	Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.6	Hemoglobinuria due to hemolysis from other external causes	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.8	Other acquired hemolytic anemias	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D59.9	Acquired hemolytic anemia, unspecified	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D60.0	Chronic acquired pure red cell aplasia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D60.1	Transient acquired pure red cell aplasia	ccm	not risk adjusted
D60.8	Other acquired pure red cell aplasias	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D60.9	Acquired pure red cell aplasia, unspecified	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D61.01	Constitutional (pure) red blood cell aplasia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D61.02	Shwachman-Diamond syndrome	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D61.03	Fanconi anemia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D61.09	Other constitutional aplastic anemia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D61.1	Drug-induced aplastic anemia	ccm	not risk adjusted
D61.2	Aplastic anemia due to other external agents	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D61.3	Idiopathic aplastic anemia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D61.810	Antineoplastic chemotherapy induced pancytopenia	ccm	not risk adjusted
D61.811	Other drug-induced pancytopenia	ccm	not risk adjusted
D61.818	Other pancytopenia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D61.82	Myelophthisis	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D61.89	Other specified aplastic anemias and other bone marrow failure syndromes	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D61.9	Aplastic anemia, unspecifiedlow specificity	ccm	not risk adjusted
D62	Acute posthemorrhagic anemia	ccm	not risk adjusted
D63.0	Anemia in neoplastic disease	ccm	not risk adjusted
D63.1	Anemia in chronic kidney disease	ccm	not risk adjusted
D63.8	Anemia in other chronic diseases classified elsewhere	ccm	not risk adjusted
D64.0	Hereditary sideroblastic anemia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D64.1	Secondary sideroblastic anemia due to disease	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D64.2	Secondary sideroblastic anemia due to drugs and toxins	ccm	not risk adjusted
D64.3	Other sideroblastic anemias	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D64.4	Congenital dyserythropoietic anemia	ccm	HCC 109 · Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
D64.81	Anemia due to antineoplastic chemotherapy	ccm	not risk adjusted
D64.89	Other specified anemias	ccm	not risk adjusted
D64.9	Anemia, unspecifiedlow specificity	ccm	not risk adjusted

Pressure ulcers and chronic ulcers

L89, L97, L98.4407 codes in familyccmpcmrtm

Repositioning and mobility surveillance alongside structured wound assessment.

CMS other chronic or potentially disabling condition · CCW category: Pressure Ulcers and Chronic Ulcers · Devices: Contactless activity and fall radar

This family runs to 407 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 L89, L97, L98.4.

Glaucoma

H40, H42253 codes in familyccm

Adherence to topical therapy and attendance at pressure checks. No remote physiologic parameter, so this supports CCM rather than RPM.

CMS chronic condition · CCW category: Glaucoma

This family runs to 253 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 H40, H42.

Cataract

H25, H26, H28100 codes in familyccm

Falls and functional risk in the elderly. No remote physiologic parameter.

CMS chronic condition · CCW category: Cataract

This family runs to 100 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 H25, H26, H28.

Blindness and visual impairment

H53.4, H5469 codes in familyccm

Falls and safety surveillance in the home.

CMS other chronic or potentially disabling condition · CCW category: Sensory - Blindness and Visual Impairment · Devices: Contactless activity and fall radar

This family runs to 69 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 H53.4, H54.

Deafness and hearing impairment

H90, H9139 codesccm

Care coordination and communication support.

CMS other chronic or potentially disabling condition · CCW category: Sensory - Deafness and Hearing Impairment

Code	Official ICD-10-CM description	Programs	Risk adjustment
H90.0	Conductive hearing loss, bilateral	ccm	not risk adjusted
H90.11	Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side	ccm	not risk adjusted
H90.12	Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side	ccm	not risk adjusted
H90.2	Conductive hearing loss, unspecified	ccm	not risk adjusted
H90.3	Sensorineural hearing loss, bilateral	ccm	not risk adjusted
H90.41	Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side	ccm	not risk adjusted
H90.42	Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side	ccm	not risk adjusted
H90.5	Unspecified sensorineural hearing loss	ccm	not risk adjusted
H90.6	Mixed conductive and sensorineural hearing loss, bilateral	ccm	not risk adjusted
H90.71	Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side	ccm	not risk adjusted
H90.72	Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side	ccm	not risk adjusted
H90.8	Mixed conductive and sensorineural hearing loss, unspecified	ccm	not risk adjusted
H90.A11	Conductive hearing loss, unilateral, right ear with restricted hearing on the contralateral side	ccm	not risk adjusted
H90.A12	Conductive hearing loss, unilateral, left ear with restricted hearing on the contralateral side	ccm	not risk adjusted
H90.A21	Sensorineural hearing loss, unilateral, right ear, with restricted hearing on the contralateral side	ccm	not risk adjusted
H90.A22	Sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side	ccm	not risk adjusted
H90.A31	Mixed conductive and sensorineural hearing loss, unilateral, right ear with restricted hearing on the contralateral side	ccm	not risk adjusted
H90.A32	Mixed conductive and sensorineural hearing loss, unilateral, left ear with restricted hearing on the contralateral side	ccm	not risk adjusted
H91.01	Ototoxic hearing loss, right ear	ccm	not risk adjusted
H91.02	Ototoxic hearing loss, left ear	ccm	not risk adjusted
H91.03	Ototoxic hearing loss, bilateral	ccm	not risk adjusted
H91.09	Ototoxic hearing loss, unspecified ear	ccm	not risk adjusted
H91.10	Presbycusis, unspecified ear	ccm	not risk adjusted
H91.11	Presbycusis, right ear	ccm	not risk adjusted
H91.12	Presbycusis, left ear	ccm	not risk adjusted
H91.13	Presbycusis, bilateral	ccm	not risk adjusted
H91.20	Sudden idiopathic hearing loss, unspecified ear	ccm	not risk adjusted
H91.21	Sudden idiopathic hearing loss, right ear	ccm	not risk adjusted
H91.22	Sudden idiopathic hearing loss, left ear	ccm	not risk adjusted
H91.23	Sudden idiopathic hearing loss, bilateral	ccm	not risk adjusted
H91.3	Deaf nonspeaking, not elsewhere classified	ccm	not risk adjusted
H91.8X1	Other specified hearing loss, right ear	ccm	not risk adjusted
H91.8X2	Other specified hearing loss, left ear	ccm	not risk adjusted
H91.8X3	Other specified hearing loss, bilateral	ccm	not risk adjusted
H91.8X9	Other specified hearing loss, unspecified ear	ccm	not risk adjusted
H91.90	Unspecified hearing loss, unspecified ear	ccm	not risk adjusted
H91.91	Unspecified hearing loss, right ear	ccm	not risk adjusted
H91.92	Unspecified hearing loss, left ear	ccm	not risk adjusted
H91.93	Unspecified hearing loss, bilateral	ccm	not risk adjusted

Clinical Context

Why geriatrics practices benefit from CCM.

Geriatrics 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.

Heart Failure

I50.1, I50.20, I50.30

COPD

J44.0, J44.1, J44.9

Atrial Fibrillation

I48.0, I48.1, I48.2

Depression & Anxiety

F32.1, F32.2, F33.0

FAQ

Common questions.

What ICD-10 codes qualify geriatrics 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 geriatrics, 753 billable ICD-10-CM codes cover the conditions CCM manages, spanning 28 conditions including essential hypertension, heart failure, atrial fibrillation and flutter, ischemic heart disease, stroke, tia and cerebrovascular sequelae, peripheral and visceral vascular disease.

How does CCN Health support geriatrics practices with CCM?

CCN Health provides turnkey CCM services for geriatrics practices, including patient eligibility identification, enrollment documentation, device provisioning, clinical monitoring, and full Medicare billing support.

What is the revenue potential for CCM in geriatrics?

Reimbursement varies by locality and payer contract, so see the CCM billing guide for current figures. Geriatrics 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.

Ready to Get Started?

Ready to launch CCM for your geriatrics practice?

Book a short discovery call and we’ll map out a program tailored to your workflows, EHR, and patient population.

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.

CCM Qualifying Diagnosesfor Geriatrics.