Question 1

What is ICD-10 code E28.310?

Accepted Answer

E28.310 is the ICD-10-CM diagnosis code for symptomatic premature menopause. Early menopause occurring before age 40 with noticeable symptoms such as hot flashes, night sweats, or mood changes. E28.310 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).

E28.310 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.

Document the specific symptoms the patient is experiencing to support medical necessity for treatment.

Question 2

Is E28.310 an HCC code?

Accepted Answer

No. E28.310 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is E28.310 billable?

Accepted Answer

Yes. E28.310 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. E28.310 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.

Question 4

Which HCC does E28.310 map to under V28?

Accepted Answer

E28.310 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.

Question 5

What does E28.310 pay in RAF?

Accepted Answer

E28.310 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for E28.310?

Accepted Answer

E28.310 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 E28.310 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports E28.310?

Accepted Answer

Document the specific symptoms the patient is experiencing to support medical necessity for treatment Distinguish from asymptomatic premature menopause (E28.319) which requires different coding E28.310 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.

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E28.310

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E28.310 ICD-10-CM Code: Symptomatic premature menopause

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E28.310

Is E28.310 an HCC code?

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What This Code Means

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Work E28.310 in HCC Buddy