E85.4
BillableOrgan-limited amyloidosis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E85.4 an HCC code?
Yes. E85.4 maps to Glycogen/Amino-Acid/Other Metabolic Disorders under the CMS-HCC V28 risk adjustment model (and Other Significant Endocrine and Metabolic Disorders under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for E85.4
For E85.4 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 E85.4 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E85.4 is the ICD-10-CM diagnosis code for organ-limited amyloidosis. Organ-limited amyloidosis is a localized form where abnormal protein deposits affect only one specific organ, such as the heart, kidneys, or skin, rather than multiple body systems. E85.4 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).
Under the CMS-HCC V28 risk adjustment model, E85.4 maps to Glycogen/Amino-Acid/Other Metabolic Disorders (HCC 50) with a community, non-dual, aged base RAF weight of 0.289. Under the older CMS-HCC V24 model, E85.4 maps to Other Significant Endocrine and Metabolic Disorders (HCC 23) with a community, non-dual, aged base RAF weight of 0.230. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Specify which organ is affected in the documentation; this helps clarify the extent and prognosis of the disease. Because E85.4 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E85.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify which organ is affected in the documentation; this helps clarify the extent and prognosis of the disease
- •Ensure the amyloidosis is truly limited to one organ; if multiple organs are involved, use a different E85 code
Clinical Significance
Organ-limited (localized) amyloidosis involves amyloid deposition confined to a single organ, such as the bladder, skin, larynx, or tracheobronchial tree. Unlike systemic forms, it generally has a better prognosis and does not progress to multi-organ involvement, though it may cause significant local symptoms.
Documentation Requirements
- ✓Confirmed amyloidosis diagnosis by tissue biopsy of the affected organ
- ✓Documentation that amyloid deposits are LIMITED to a single organ
- ✓Specific organ involved identified in documentation
- ✓Exclusion of systemic amyloidosis (no evidence of multi-organ involvement)
- ✓Monitoring plan to ensure the condition remains localized
- ✓Treatment approach for the affected organ