F50.24 ICD-10-CM Code: Bulimia nervosa, extreme
HCC Buddy Code Card
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Behavioral syndromes associated with physiological disturbances and physical factors (F50-F59)
F50.24
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBulimia nervosa, extreme
A severe eating disorder characterized by repeated cycles of eating large amounts of food followed by compensatory behaviors like vomiting or excessive exercise.
Buddy Insight
Bulimia nervosa involves recurrent episodes of binge eating followed by inappropriate compensatory behaviors (self-induced vomiting, laxative/diuretic misuse, fasting, excessive exercise) in a patient at normal or above-normal weight.
CMS-HCC V28
MappedHCC 153
RAF 0.396
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
MappedHCC 94
Varies by metal level
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 133
RAF 0.035
Code Book Path
Inclusion Terms
Official- Bulimia nervosa with 14 or more episodes of inappropriate compensatory behavior per week
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for F50.24 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for F50.24 in this effective period.
Excludes 1
Official- anorexia nervosa, binge eating/purging type (F50.02-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for F50.24 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for F50.24 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for F50.24 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 F50.24 an HCC code?
Yes. F50.24 (Bulimia nervosa, extreme) maps to Personality Disorders; Anorexia/Bulimia Nervosa under the CMS-HCC V28 risk adjustment model, with a community non-dual aged RAF of 0.396. It is billable for payment year 2026.
Coder answer: F50.24 is billable and maps to V28 HCC 153, Personality Disorders; Anorexia/Bulimia Nervosa. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F50.24
- Description
- Bulimia nervosa, extreme
- HCC (V28)
- HCC 153 — Personality Disorders; Anorexia/Bulimia Nervosa
- RAF
- 0.396
- 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 F50.24 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for F50.24
For F50.24 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 F50.24 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
F50.24 is the ICD-10-CM diagnosis code for bulimia nervosa, extreme. A severe eating disorder characterized by repeated cycles of eating large amounts of food followed by compensatory behaviors like vomiting or excessive exercise. F50.24 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering behavioral syndromes associated with physiological disturbances and physical factors (f50-f59).
Under the CMS-HCC V28 risk adjustment model, F50.24 maps to Personality Disorders; Anorexia/Bulimia Nervosa (HCC 153) with a community, non-dual, aged base RAF weight of 0.396. F50.24 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. 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.
This code indicates extreme severity - verify documentation supports this level. Because F50.24 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 F50.24 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates extreme severity - verify documentation supports this level
- •Look for evidence of significant medical complications or functional impairment
Clinical Significance
Bulimia nervosa involves recurrent episodes of binge eating followed by inappropriate compensatory behaviors (self-induced vomiting, laxative/diuretic misuse, fasting, excessive exercise) in a patient at normal or above-normal weight. Extreme bulimia (14+ compensatory episodes per week) represents near-constant purging with imminent risk of life-threatening complications. Unlike anorexia nervosa, patients with bulimia are not significantly underweight, which can make the condition less visually apparent.
Documentation Requirements
- ✓Recurrent episodes of binge eating (consuming objectively large amounts of food with sense of loss of control)
- ✓Recurrent inappropriate compensatory behaviors to prevent weight gain (14 or more episodes per week)
- ✓Binge eating and compensatory behaviors occur at least once per week for three months
- ✓Self-evaluation unduly influenced by body shape and weight
- ✓Disturbance does not occur exclusively during episodes of anorexia nervosa (patient is NOT significantly underweight)
Commonly Confused Codes
- •F50.02x (Anorexia nervosa, binge eating/purging type): patient is significantly UNDERWEIGHT, unlike bulimia
- •F50.81x (Binge eating disorder): binge eating WITHOUT compensatory purging behaviors
- •F50.9 (Eating disorder, unspecified): use specific bulimia code when criteria are documented
- •F50.89 (Other specified eating disorder): use for purging disorder (purging without binge eating) or subthreshold bulimia
- •E87.1 (Hypo-osmolality and hyponatremia): complication code, not the eating disorder itself