G40.B01 ICD-10-CM Code: Juvenile myoclonic epilepsy, not intractable, with status epilepticus
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Episodic and paroxysmal disorders (G40-G47)
G40.B01
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceJuvenile myoclonic epilepsy, not intractable, with status epilepticus
Juvenile myoclonic epilepsy (sudden involuntary muscle jerks, typically in adolescents) that responds to medication, currently experiencing status epilepticus.
Buddy Insight
Juvenile myoclonic epilepsy (JME) with status epilepticus is a serious complication of this common adolescent-onset generalized epilepsy.
CMS-HCC V28
MappedHCC 201
RAF 0.262
CMS-HCC V24
MappedHCC 79
RAF 0.244
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 79
RAF 0.0
RXHCC
MappedHCC 164
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for G40.B01 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G40.B01 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G40.B01 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G40.B01 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G40.B01 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G40.B01 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G40.B01 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is G40.B01 an HCC code?
Yes. G40.B01 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.B01
For G40.B01to 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.B01 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
G40.B01 is the ICD-10-CM diagnosis code for juvenile myoclonic epilepsy, not intractable, with status epilepticus. Juvenile myoclonic epilepsy (sudden involuntary muscle jerks, typically in adolescents) that responds to medication, currently experiencing status epilepticus. G40.B01 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.B01 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.B01 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.
Juvenile myoclonic epilepsy typically begins in adolescence with myoclonic jerks upon waking. Because G40.B01 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.B01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Juvenile myoclonic epilepsy typically begins in adolescence with myoclonic jerks upon waking
- •Status epilepticus in this condition may involve repeated myoclonic jerks or generalized tonic-clonic seizures
Clinical Significance
Juvenile myoclonic epilepsy (JME) with status epilepticus is a serious complication of this common adolescent-onset generalized epilepsy. JME is characterized by myoclonic jerks upon awakening, generalized tonic-clonic seizures, and sometimes absence seizures. Status epilepticus may involve myoclonic status or generalized convulsive status, both requiring emergency management.
Documentation Requirements
- ✓Confirmed JME diagnosis based on clinical history and EEG findings
- ✓Documentation of active status epilepticus during the encounter
- ✓Seizure types present (myoclonic, tonic-clonic, absence)
- ✓Statement that condition responds to medication (not intractable)
- ✓Emergency interventions provided
- ✓Typical triggers (sleep deprivation, alcohol, photic stimulation)
Commonly Confused Codes
- •G40.B09 — JME, not intractable, WITHOUT status epilepticus
- •G40.B11 — JME, INTRACTABLE, with status epilepticus
- •G40.A01 — Absence epilepsy with status epilepticus; JME may include absences but is a distinct syndrome
- •G40.C01 — Lafora progressive myoclonus epilepsy with status epilepticus; progressive and degenerative unlike JME
- •G40.401 — Other generalized epilepsy with status epilepticus; use when JME is not confirmed