Question 1

What is ICD-10 code E65?

Accepted Answer

E65 is the ICD-10-CM diagnosis code for localized adiposity. Excessive fat deposits in specific areas of the body, such as the abdomen or neck. E65 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering overweight, obesity and other hyperalimentation (e65-e68).

E65 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 is for localized fat accumulation, not generalized obesity.

Question 2

Is E65 an HCC code?

Accepted Answer

No. E65 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 E65 billable?

Accepted Answer

Yes. E65 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. E65 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

What is the V28 vs V24 difference for E65?

Accepted Answer

E65 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 model rewards E65 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting E65?

Accepted Answer

This code is for localized fat accumulation, not generalized obesity Document the anatomical location of the adiposity when specified

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E65

Is E65 an HCC code?

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E65 ICD-10-CM Code: Localized adiposity

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E65

Is E65 an HCC code?

What This Code Means

Coding Tips

Code Hierarchy

Work E65 in HCC Buddy