What is ICD-10 code E04.2?

E04.2 is the ICD-10-CM diagnosis code for Nontoxic multinodular goiter. Multiple lumps or nodules throughout the thyroid gland that are not producing excess thyroid hormone. It belongs to the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89). E04.2 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E04.2 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E04.2 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E04.2 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does E04.2 map to under V28?

E04.2 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

What does E04.2 pay in RAF?

E04.2 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

What is the V28 vs V24 difference for E04.2?

E04.2 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards E04.2 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. It does, however, map under the Part D RxHCC model (Thyroid and Parathyroid Disorders), which affects the ESRD and/or Part D (RxHCC) risk scores. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

What documentation supports E04.2?

Confirm multiple nodules are present; if only one nodule exists, use E04.1 instead Document the number of nodules and any concerning features noted on imaging or biopsy E04.2 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

2026 ICD-10-CM E04.2: Nontoxic multinodular goiter

E04.2 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC coding software

ICD-10-CM Code View

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Code lookupE04.2Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Disorders of thyroid gland (E00-E07)

E04.2

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Nontoxic multinodular goiter

Multiple lumps or nodules throughout the thyroid gland that are not producing excess thyroid hormone.

Buddy Insight

Nontoxic multinodular goiter represents a thyroid gland with multiple nodules and preserved euthyroid function.

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 44

Thyroid and Parathyroid Disor...

RAF 0.070

Code Book Path

Official

E04Other nontoxic goiter

E04.2Nontoxic multinodular goiter

Inclusion Terms

Official

Cystic goiter NOS
Multinodular (cystic) goiter NOS

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E04.2 in this effective period.

Related Child Codes

Official

E04.0Nontoxic diffuse goiter

E04.1Nontoxic single thyroid nodule

E04.8Other specified nontoxic goiter

E04.9Nontoxic goiter, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for E04.2 in this effective period.

Excludes 1

Official

congenital goiter (NOS) (diffuse) (parenchymatous) (E03.0)
iodine-deficiency related goiter (E00-E02)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E04.2 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E04.2 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E04.2 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation should confirm multiple thyroid nodules with normal thyroid function tests.

Thyroid ultrasound describing the number, size, and characteristics of individual nodules should be recorded.

Fine-needle aspiration results for suspicious nodules per American Thyroid Association guidelines and the surveillance plan should be documented.

Assessment for compressive symptoms (dysphagia, dyspnea) should be noted.

MEAT Support

HCC Buddy guidance

Documentation should confirm multiple thyroid nodules with normal thyroid function tests.

Thyroid ultrasound describing the number, size, and characteristics of individual nodules should be recorded.

Fine-needle aspiration results for suspicious nodules per American Thyroid Association guidelines and the surveillance plan should be documented.

Assessment for compressive symptoms (dysphagia, dyspnea) should be noted.

Audit Caution

HCC Buddy guidance

Do not assign this code if thyroid function is abnormal; hyperthyroid multinodular goiter requires E05.

Ensure the distinction from iodine-deficiency related multinodular goiter (E01.1) when iodine deficiency is the established cause. Each suspicious nodule should be evaluated independently for malignancy risk. Do not use E04.8 (Other specified nontoxic goiter) when multinodular pattern is clearly documented.

Common Mistakes

HCC Buddy guidance

E04.1 (Nontoxic single thyroid nodule) is used for a solitary nodule.

E01.1 (Iodine-deficiency related multinodular goiter) requires documented iodine-deficiency etiology.

E05.20 (Thyrotoxicosis with toxic multinodular goiter) captures multinodular goiter with hyperthyroidism.

E04.0 (Nontoxic diffuse goiter) captures diffuse enlargement without distinct nodules.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is E04.2 an HCC code?

E04.2 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Thyroid and Parathyroid Disorders under the Part D RxHCC model.

Code: E04.2
Description: Nontoxic multinodular goiter
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

RxHCCHCC 44, Thyroid and Parathyroid Disorders

0.070

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work E04.2 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E04.2

For E04.2 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E04.2 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E04.2 is the ICD-10-CM diagnosis code for nontoxic multinodular goiter. Multiple lumps or nodules throughout the thyroid gland that are not producing excess thyroid hormone. E04.2 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering disorders of thyroid gland (e00-e07).

E04.2 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing E04.2 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E04.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Confirm multiple nodules are present; if only one nodule exists, use E04.1 instead
•Document the number of nodules and any concerning features noted on imaging or biopsy

Clinical Significance

Nontoxic multinodular goiter represents a thyroid gland with multiple nodules and preserved euthyroid function. It is one of the most common thyroid disorders, particularly in older adults and women. The clinical significance includes the risk of malignancy within individual nodules (each dominant nodule should be evaluated independently), potential progression to toxic multinodular goiter with autonomous hormone production, and compressive symptoms from goiter enlargement.

Documentation Requirements

✓Documentation should confirm multiple thyroid nodules with normal thyroid function tests.
✓Thyroid ultrasound describing the number, size, and characteristics of individual nodules should be recorded.
✓Fine-needle aspiration results for suspicious nodules per American Thyroid Association guidelines and the surveillance plan should be documented.
✓Assessment for compressive symptoms (dysphagia, dyspnea) should be noted.

Commonly Confused Codes

•E04.1 (Nontoxic single thyroid nodule) is used for a solitary nodule.
•E01.1 (Iodine-deficiency related multinodular goiter) requires documented iodine-deficiency etiology.
•E05.20 (Thyrotoxicosis with toxic multinodular goiter) captures multinodular goiter with hyperthyroidism.
•E04.0 (Nontoxic diffuse goiter) captures diffuse enlargement without distinct nodules.