G40.801
BillableOther epilepsy, 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 G40.801 an HCC code?
Yes. G40.801 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 G40.801
For G40.801 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 G40.801 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G40.801 is the ICD-10-CM diagnosis code for other epilepsy, not intractable, with status epilepticus. A form of epilepsy that doesn't fit other specific categories and can be controlled with medication, currently experiencing a prolonged seizure state. G40.801 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, G40.801 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, G40.801 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.
Use this code when epilepsy doesn't meet criteria for other specific syndromes like Lennox-Gastaut. Because G40.801 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 G40.801 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when epilepsy doesn't meet criteria for other specific syndromes like Lennox-Gastaut
- •Status epilepticus is a life-threatening condition; document emergency treatment provided
Clinical Significance
Other epilepsy with status epilepticus is a catch-all for epilepsy types not classified elsewhere that present with a life-threatening prolonged seizure state. This code captures epilepsy presentations that do not fit into specific syndrome categories like Lennox-Gastaut or absence epilepsy. Status epilepticus requires emergency intervention and carries significant morbidity and mortality risk.
Documentation Requirements
- ✓Documentation of epilepsy type that does not fit other specific ICD-10 epilepsy categories
- ✓Active status epilepticus documented during the encounter
- ✓Statement that seizures are not intractable (medication-responsive)
- ✓Emergency treatments administered for status epilepticus
- ✓Seizure characteristics and clinical presentation
- ✓Rationale for why more specific epilepsy codes do not apply
Commonly Confused Codes
- •G40.802 — Same epilepsy type but WITHOUT status epilepticus
- •G40.803 — Same type WITH status epilepticus but INTRACTABLE
- •G40.401 — Other GENERALIZED epilepsy with status epilepticus; use when generalized type is documented
- •G40.901 — UNSPECIFIED epilepsy with status epilepticus; even less specific
- •G40.811 — Lennox-Gastaut syndrome with status epilepticus; use when this specific syndrome is diagnosed