What is ICD-10 code G54.6?

G54.6 is the ICD-10-CM diagnosis code for Phantom limb syndrome with pain. Persistent pain felt in a limb that has been amputated or lost, where the patient feels sensations as if the missing limb is still present. G54.6 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. G54.6 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. G54.6 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. G54.6 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does G54.6 map to under V28?

G54.6 maps to CMS-HCC V28 HCC 409 (Amputation Status, Lower Limb/Amputation Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM G54.6: Phantom limb syndrome

G54.6 maps to CMS-HCC V28 409. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupG54.6Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Nerve, nerve root and plexus disorders (G50-G59)

G54.6

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Phantom limb syndrome with pain

Persistent pain felt in a limb that has been amputated or lost, where the patient feels sensations as if the missing limb is still present.

Buddy Insight

Phantom limb syndrome with pain is a complex neuropathic condition where patients experience painful sensations perceived as coming from an amputated or missing limb.

CMS-HCC V28

Mapped

HCC 409

Amputation Status, Lower Limb...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 254

HHS-HCC 254 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 189

Amputation Status/Lower Limb/...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

G54Nerve root and plexus disorders

G54.6Phantom limb syndrome with pain

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for G54.6 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for G54.6 in this effective period.

Related Child Codes

Official

G54.0Brachial plexus disorders

G54.1Lumbosacral plexus disorders

G54.2Cervical root disorders, not elsewhere classified

G54.3Thoracic root disorders, not elsewhere classified

G54.4Lumbosacral root disorders, not elsewhere classified

Includes

Official

ICD-10-CM does not list Includes notes for G54.6 in this effective period.

Excludes 1

Official

current traumatic nerve root and plexus disorders - see nerve injury by body region
intervertebral disc disorders (M50-M51)
neuralgia or neuritis NOS (M79.2)
neuritis or radiculitis brachial NOS (M54.13)
neuritis or radiculitis lumbar NOS (M54.16)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for G54.6 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for G54.6 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for G54.6 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

History of limb amputation or congenital limb absence documented

Description of phantom pain: type (burning, shooting, cramping, crushing), location within phantom limb, intensity

Pain frequency and duration (episodic vs. constant)

Distinction from residual limb (stump) pain which is a different condition

MEAT Support

HCC Buddy guidance

History of limb amputation or congenital limb absence documented

Description of phantom pain: type (burning, shooting, cramping, crushing), location within phantom limb, intensity

Pain frequency and duration (episodic vs. constant)

Distinction from residual limb (stump) pain which is a different condition

Audit Caution

HCC Buddy guidance

Confusing phantom limb pain (pain perceived in the missing limb) with residual limb/stump pain (pain at the amputation site) — these are different conditions with different codes

Not documenting the pain component, which distinguishes G54.6 from G54.7 (without pain)

Coding chronic pain syndrome (G89.4) instead of the specific phantom limb pain code

Using limb pain codes (M79.6x) for phantom limb sensations — the limb is absent

Common Mistakes

HCC Buddy guidance

G54.7 (Phantom limb syndrome without pain) — phantom sensations present but not painful; different code and clinical management

G54.4 (Lumbosacral root disorders) — nerve root pathology, not phantom limb phenomenon

T87.30-T87.9 (Complications of reattached extremity/amputation stump) — stump complications are distinct from phantom limb

G89.4 (Chronic pain syndrome) — general chronic pain; phantom limb pain has a specific code

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is G54.6 an HCC code?

Yes. G54.6 (Phantom limb syndrome with pain) maps to HCC 409, Amputation Status, Lower Limb/Amputation Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.598. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: G54.6 is billable and maps to V28 HCC 409, Amputation Status, Lower Limb/Amputation Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: G54.6
Description: Phantom limb syndrome with pain
HCC (V28): HCC 409 — Amputation Status, Lower Limb/Amputation Complications
RAF reference coefficient: 0.598
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 409, Amputation Status, Lower Limb/Amputation Complications

0.598

ESRDHCC 189, Amputation Status/Lower Limb/Amputation Complications

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work G54.6 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for G54.6

For G54.6 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 G54.6 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

G54.6 is the ICD-10-CM diagnosis code for phantom limb syndrome with pain. Persistent pain felt in a limb that has been amputated or lost, where the patient feels sensations as if the missing limb is still present. G54.6 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering nerve, nerve root and plexus disorders (g50-g59).

Under the CMS-HCC V28 risk adjustment model, G54.6 maps to Amputation Status, Lower Limb/Amputation Complications (HCC 409) with a source-labeled community, non-dual, aged reference coefficient of 0.598. No V24 mapping is shown for G54.6; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Specify which limb is affected and laterality. Because G54.6 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for G54.6 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Specify which limb is affected and laterality
•Document whether pain is the primary complaint versus other phantom sensations

Clinical Significance

Phantom limb syndrome with pain is a complex neuropathic condition where patients experience painful sensations perceived as coming from an amputated or missing limb. This condition affects 50-80% of amputees and significantly impacts rehabilitation, prosthetic use, and quality of life.

Documentation Requirements

✓History of limb amputation or congenital limb absence documented
✓Description of phantom pain: type (burning, shooting, cramping, crushing), location within phantom limb, intensity
✓Pain frequency and duration (episodic vs. constant)
✓Distinction from residual limb (stump) pain which is a different condition
✓Functional impact: effect on prosthetic use, sleep, rehabilitation participation
✓Current pain management regimen (medications, mirror therapy, TENS, nerve blocks)
✓Assessment of pain severity using validated scale

Commonly Confused Codes

•G54.7 (Phantom limb syndrome without pain): phantom sensations present but not painful; different code and clinical management
•G54.4 (Lumbosacral root disorders): nerve root pathology, not phantom limb phenomenon
•T87.30-T87.9 (Complications of reattached extremity/amputation stump): stump complications are distinct from phantom limb
•G89.4 (Chronic pain syndrome): general chronic pain; phantom limb pain has a specific code
•M79.60x (Pain in limb): use for pain in an existing limb, not a phantom limb