G21.4
BillableVascular parkinsonism
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G21.4 an HCC code?
Yes. G21.4 maps to Parkinson and Huntington Diseases under the CMS-HCC V28 risk adjustment model (and Parkinson's and Huntington's Diseases 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 G21.4
For G21.4 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 G21.4 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G21.4 is the ICD-10-CM diagnosis code for vascular parkinsonism. Parkinson-like symptoms caused by stroke or reduced blood flow to areas of the brain that control movement. G21.4 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering extrapyramidal and movement disorders (g20-g26).
Under the CMS-HCC V28 risk adjustment model, G21.4 maps to Parkinson and Huntington Diseases (HCC 199) with a community, non-dual, aged base RAF weight of 0.000. Under the older CMS-HCC V24 model, G21.4 maps to Parkinson's and Huntington's Diseases (HCC 78) with a community, non-dual, aged base RAF weight of 0.584. 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.
Document the location and type of cerebrovascular disease contributing to the parkinsonism. Because G21.4 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 G21.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Vascular parkinsonism results from cerebrovascular disease affecting the basal ganglia, typically presenting with lower-body predominant symptoms ('lower half parkinsonism') after stroke or chronic small vessel disease. This diagnosis links cerebrovascular and movement disorder management, requiring treatment of both the vascular risk factors and the motor symptoms.
Documentation Requirements
- ✓Brain imaging (MRI or CT) showing cerebrovascular disease affecting basal ganglia or subcortical white matter
- ✓Clinical presentation consistent with vascular parkinsonism (lower body predominant, gait freezing)
- ✓Documented cerebrovascular disease history (stroke, chronic small vessel disease, lacunar infarcts)
- ✓Poor or no response to levodopa (distinguishing feature from idiopathic Parkinson's disease)
- ✓Underlying cerebrovascular condition coded separately (I63.x, I67.x, etc.)
- ✓Vascular risk factor assessment and management plan
Commonly Confused Codes
- •G20.A1-G20.C — Parkinson's disease: idiopathic, typically levodopa-responsive with upper extremity onset
- •I69.398 — Other sequelae of cerebral infarction: for post-stroke sequelae without specific parkinsonian features
- •G21.8 — Other secondary parkinsonism: for secondary causes other than vascular disease
- •G21.9 — Secondary parkinsonism, unspecified: less specific, should not be used when vascular etiology is confirmed