E55.0 ICD-10-CM Code: Rickets, active
E55.0 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Other nutritional deficiencies (E50-E64)
E55.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceRickets, active
A condition where bones fail to develop properly in children due to vitamin D deficiency, causing soft and weak bones that may become deformed.
Buddy Insight
Active rickets is a childhood bone disorder caused by severe vitamin D deficiency, leading to defective mineralization of growing bones.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 87
RAF 0.055
Code Book Path
Inclusion Terms
Official- Infantile osteomalacia
- Juvenile osteomalacia
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E55.0 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E55.0 in this effective period.
Excludes 1
Official- celiac rickets (K90.0)
- Crohn's rickets (K50.-)
- hereditary vitamin D-dependent rickets (E83.32)
- inactive rickets (E64.3)
- renal rickets (N25.0)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E55.0 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E55.0 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E55.0 in this effective period.
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 E55.0 an HCC code?
E55.0 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Osteoporosis, Vertebral and Pathological Fractures under the Part D RxHCC model.
- Code
- E55.0
- Description
- Rickets, active
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 E55.0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E55.0
For E55.0 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 E55.0 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E55.0 is the ICD-10-CM diagnosis code for rickets, active. A condition where bones fail to develop properly in children due to vitamin D deficiency, causing soft and weak bones that may become deformed. E55.0 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering other nutritional deficiencies (e50-e64).
E55.0 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 E55.0 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 E55.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for active rickets cases; ensure documentation specifies vitamin D deficiency as the cause
- •This is a manifestation code - always investigate and code the underlying vitamin D deficiency separately if not already documented
Clinical Significance
Active rickets is a childhood bone disorder caused by severe vitamin D deficiency, leading to defective mineralization of growing bones. Children present with bowed legs, widened wrists and ankles, rachitic rosary (costochondral beading), craniotabes, and growth retardation. Early recognition and treatment with vitamin D supplementation can prevent permanent skeletal deformities and fractures.
Documentation Requirements
- ✓Documentation must include clinical findings (skeletal deformities, growth impairment), radiographic evidence showing widened growth plates with fraying and cupping, and laboratory results confirming vitamin D deficiency (low 25-hydroxyvitamin D), elevated alkaline phosphatase, and potentially low calcium and phosphorus levels.
- ✓The provider should document the cause of vitamin D deficiency (dietary, malabsorption, lack of sun exposure) and treatment initiated.
Excludes 1, Do NOT code together
Commonly Confused Codes
- •E55.9 (Vitamin D deficiency, unspecified) captures the deficiency without skeletal manifestations.
- •E64.3 (Sequelae of rickets) is for residual deformities after rickets has resolved.
- •M83.x (Adult osteomalacia) is the adult equivalent of rickets.
- •E83.30-E83.39 (Disorders of phosphorus metabolism) may cause rickets through a different mechanism.
- •E20.x (Hypoparathyroidism) can also cause calcium-phosphorus imbalances.