E22.1 ICD-10-CM Code: Hyperprolactinemia
E22.1 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Disorders of other endocrine glands (E20-E35)
E22.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHyperprolactinemia
A condition where the pituitary gland produces too much prolactin hormone, leading to elevated prolactin levels in the blood and potential symptoms like galactorrhea or reproductive dysfunction.
Buddy Insight
Hyperprolactinemia involves excessive prolactin secretion, most commonly from a pituitary prolactinoma, causing galactorrhea, menstrual irregularities, infertility, and decreased bone density.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 030
Code-level coefficient reference
ESRD/PACE
MappedHCC 23
Code-level coefficient reference
RXHCC
MappedHCC 43
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for E22.1. Check the code and parent instructions in the Code Book.
Excludes 2
OfficialNo Excludes 2 notes are included in this display for E22.1. Check the code and parent instructions in the Code Book.
Related Codes
Includes
OfficialNo Includes notes are included in this display for E22.1. Check the code and parent instructions in the Code Book.
Excludes 1
Official- transitory endocrine and metabolic disorders specific to newborn (P70-P74)Inherited from E00-E89, E20-E35, E22
- galactorrhea (N64.3)Inherited from E00-E89, E20-E35, E22
- gynecomastia (N62)Inherited from E00-E89, E20-E35, E22
- Cushing's syndrome (E24.-)Inherited from E00-E89, E20-E35, E22
- Nelson's syndrome (E24.1)Inherited from E00-E89, E20-E35, E22
- overproduction of ACTH not associated with Cushing's disease (E27.0)Inherited from E00-E89, E20-E35, E22
- overproduction of pituitary ACTH (E24.0)Inherited from E00-E89, E20-E35, E22
- overproduction of thyroid-stimulating hormone (E05.8-)Inherited from E00-E89, E20-E35, E22
Code First
OfficialNo Code First sequencing instructions are included in this display for E22.1. Check the code and parent instructions in the Code Book.
Use Additional
Official- code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
Code Also
OfficialNo Code Also instructions are included in this display for E22.1. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 E22.1 an HCC code?
E22.1 has no mapping under the current CMS-HCC V28 community payment model. E22.1 has a separate mapping under the CMS-HCC ESRD model (HCC 23 (Other Significant Endocrine and Metabolic Disorders)) and the Part D RxHCC model (HCC 43 (Pituitary, Adrenal Gland, and Other Endocrine and Metabolic Disorders)); the applicable result needs member context. E22.1 also appears in the HHS-HCC commercial risk model (HCC 030 (HHS-HCC 030 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping.
- Code
- E22.1
- Description
- Hyperprolactinemia
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work E22.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E22.1
For E22.1, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
E22.1 is the ICD-10-CM diagnosis code for hyperprolactinemia. A condition where the pituitary gland produces too much prolactin hormone, leading to elevated prolactin levels in the blood and potential symptoms like galactorrhea or reproductive dysfunction. E22.1 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering disorders of other endocrine glands (e20-e35).
E22.1 has no mapping under the current CMS-HCC V28 community payment model. E22.1 has a separate mapping under the CMS-HCC ESRD model (HCC 23 (Other Significant Endocrine and Metabolic Disorders)) and the Part D RxHCC model (HCC 43 (Pituitary, Adrenal Gland, and Other Endocrine and Metabolic Disorders)); the applicable result needs member context. E22.1 also appears in the HHS-HCC commercial risk model (HCC 030 (HHS-HCC 030 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.
Document whether hyperprolactinemia is due to a prolactinoma (pituitary adenoma) or other causes, as this may affect treatment decisions.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E22.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether hyperprolactinemia is due to a prolactinoma (pituitary adenoma) or other causes, as this may affect treatment decisions
- •Note any associated symptoms such as amenorrhea, infertility, or galactorrhea for complete clinical documentation
Clinical Significance
Hyperprolactinemia involves excessive prolactin secretion, most commonly from a pituitary prolactinoma, causing galactorrhea, menstrual irregularities, infertility, and decreased bone density. In men, it may present with hypogonadism, erectile dysfunction, and gynecomastia, making it frequently underdiagnosed.
Documentation Requirements
- ✓Document the underlying cause (prolactinoma, medication-induced, hypothyroidism), prolactin level with reference range, tumor size if applicable (microprolactinoma vs macroprolactinoma), reproductive symptoms, and treatment approach (dopamine agonists, surgery).