G40.802
BillableOther epilepsy, 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 G40.802 an HCC code?
Yes. G40.802 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 G40.802
For G40.802 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 G40.802 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G40.802 is the ICD-10-CM diagnosis code for other epilepsy, not intractable, without status epilepticus. A form of epilepsy that doesn't fit other specific categories and can be controlled with medication, not currently in a prolonged seizure state. G40.802 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, G40.802 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, G40.802 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.
This is a catch-all code for epilepsy types not classified elsewhere. Because G40.802 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 G40.802 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a catch-all code for epilepsy types not classified elsewhere
- •Ensure documentation clarifies why other specific epilepsy codes were not used
Clinical Significance
Other epilepsy, not intractable, without status epilepticus captures chronic epilepsy that does not fit specific syndrome categories and is managed with medication. This is a residual category for epilepsy types not classified elsewhere. These patients require ongoing neurological follow-up and medication management but are not in acute crisis.
Documentation Requirements
- ✓Documentation of epilepsy type that does not meet criteria for specific syndromes
- ✓Confirmation seizures respond to medication (not intractable)
- ✓Absence of status epilepticus at the encounter
- ✓Current antiepileptic drug regimen
- ✓Seizure frequency and characterization
- ✓Explanation of why more specific epilepsy codes are not applicable
Commonly Confused Codes
- •G40.801 — Same type but WITH status epilepticus
- •G40.804 — Same type, INTRACTABLE, without status epilepticus
- •G40.909 — UNSPECIFIED epilepsy; less specific than 'other epilepsy'
- •G40.409 — Other GENERALIZED epilepsy; use when generalized seizure type is specified
- •G40.89 — Other seizures; used for seizure types that may not constitute epilepsy