G40.201
BillableLocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G40.201 an HCC code?
Yes. G40.201 maps to Seizure Disorders and Convulsions under the CMS-HCC V28 risk adjustment model (and Seizure Disorders and Convulsions 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 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.
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 community, non-dual, aged base RAF weight of 0.262. Under the older V24 model, G40.201 mapped to the same category but with a base RAF weight of 0.244 — V28 recalibrated weights across the entire model. 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.
The '20' indicates symptomatic with complex partial seizures; the final '1' indicates status epilepticus is present. Because G40.201 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 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