G40.201 ICD-10-CM Code: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus
G40.201 maps to CMS-HCC V28 201. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Episodic and paroxysmal disorders (G40-G47)
G40.201
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus
A type of epilepsy caused by a known brain condition with complex partial seizures (affecting multiple brain areas) that responds to medication, and the patient is currently experiencing prolonged seizure activity.
Buddy Insight
This code captures symptomatic focal epilepsy with complex partial seizures (impaired consciousness during seizures) that is medication-responsive but with current status epilepticus.
CMS-HCC V28
MappedHCC 201
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 120
Code-level coefficient reference
ESRD/PACE
MappedHCC 79
Code-level coefficient reference
RXHCC
MappedHCC 164
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures without intractability
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G40.201 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G40.201 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G40.201 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G40.201 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G40.201 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G40.201 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 G40.201 an HCC code?
Yes. G40.201 (Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus) maps to HCC 201, Seizure Disorders and Convulsions under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.245. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: G40.201 is billable and maps to V28 HCC 201, Seizure Disorders and Convulsions. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- G40.201
- Description
- Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus
- HCC (V28)
- HCC 201 — Seizure Disorders and Convulsions
- RAF reference coefficient
- 0.245
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work G40.201 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for G40.201
For G40.201 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 G40.201 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
G40.201 is the ICD-10-CM diagnosis code for localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus. A type of epilepsy caused by a known brain condition with complex partial seizures (affecting multiple brain areas) that responds to medication, and the patient is currently experiencing prolonged seizure activity. G40.201 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering episodic and paroxysmal disorders (g40-g47).
Under the CMS-HCC V28 risk adjustment model, G40.201 maps to Seizure Disorders and Convulsions (HCC 201) with a source-labeled community, non-dual, aged reference coefficient of 0.245. No V24 mapping is shown for G40.201; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
The '20' indicates symptomatic with complex partial seizures; the final '1' indicates status epilepticus is present. Because G40.201 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for G40.201 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The '20' indicates symptomatic with complex partial seizures; the final '1' indicates status epilepticus is present
- •Complex partial seizures may involve loss of consciousness or automatisms; ensure seizure type is clearly documented
Clinical Significance
This code captures symptomatic focal epilepsy with complex partial seizures (impaired consciousness during seizures) that is medication-responsive but with current status epilepticus. Complex partial seizures are more disabling than simple partial seizures because the patient loses awareness. Status epilepticus with complex partial seizures (nonconvulsive status) can be subtle and difficult to diagnose without EEG.
Documentation Requirements
- ✓Documentation of symptomatic focal epilepsy with a known underlying cause
- ✓Complex partial seizure type documented — impaired consciousness or awareness during seizures
- ✓Active status epilepticus documented (may be nonconvulsive status requiring EEG confirmation)
- ✓Statement that the epilepsy is generally not intractable (medication responsive)
- ✓Underlying etiology documented (stroke, tumor, cortical malformation, etc.)
- ✓Emergency treatment documentation and monitoring plan
Commonly Confused Codes
- •G40.101: Symptomatic focal with SIMPLE partial seizures and status epilepticus; consciousness preserved
- •G40.209: Same type WITHOUT status epilepticus; stable baseline
- •G40.211: Same type, intractable, with status epilepticus; drug-resistant form
- •G40.001: IDIOPATHIC focal epilepsy with status epilepticus; no identified cause
- •G40.301: Generalized idiopathic epilepsy with status epilepticus; generalized onset