G40.209
BillableLocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G40.209 an HCC code?
Yes. G40.209 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 G40.209
For G40.209 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 G40.209 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G40.209 is the ICD-10-CM diagnosis code for localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus. A type of epilepsy caused by a known brain condition with complex partial seizures that responds to medication, without current prolonged seizure activity. G40.209 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, G40.209 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, G40.209 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 '9' indicates no status epilepticus. Because G40.209 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 G40.209 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 '9' indicates no status epilepticus
- •Verify that seizures are not intractable and document current seizure control status
Clinical Significance
This code represents the stable baseline state of symptomatic focal epilepsy with complex partial seizures — medication-controlled and not in status epilepticus. Complex partial seizures involve impaired consciousness, making them more functionally disabling than simple partial seizures. These patients require ongoing medication management and monitoring for seizure control.
Documentation Requirements
- ✓Documentation of symptomatic focal epilepsy with identified underlying cause
- ✓Complex partial seizure type documented (impaired awareness during seizures)
- ✓Current antiepileptic medication regimen and dosing
- ✓Seizure frequency and control status
- ✓Underlying etiology documented and coded separately
- ✓Confirmation that seizures are NOT intractable and patient is NOT in status epilepticus