G54.7 ICD-10-CM Code: Phantom limb syndrome without pain
G54.7 maps to CMS-HCC V28 409. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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) / Nerve, nerve root and plexus disorders (G50-G59)
G54.7
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePhantom limb syndrome without pain
A condition where a person feels sensations in a limb that has been amputated or lost, but without pain accompanying those sensations.
Buddy Insight
Phantom limb syndrome without pain involves non-painful phantom sensations such as perceived movement, itching, pressure, or tingling in an amputated or absent limb.
CMS-HCC V28
MappedHCC 409
Coefficient HCC 409: 0.598 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 254
Code-level coefficient reference
ESRD/PACE
MappedHCC 189
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Phantom limb syndrome NOS
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from G00-G99
- certain infectious and parasitic diseases (A00-B99)Inherited from G00-G99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from G00-G99
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from G00-G99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from G00-G99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from G00-G99
- neoplasms (C00-D49)Inherited from G00-G99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from G00-G99
Related Codes
Includes
OfficialNo Includes notes are included in this display for G54.7. Check the code and parent instructions in the Code Book.
Excludes 1
Official- current traumatic nerve, nerve root and plexus disorders - see Injury, nerve by body regionInherited from G50-G59, G54
- neuralgia NOS (M79.2)Inherited from G50-G59, G54
- neuritis NOS (M79.2)Inherited from G50-G59, G54
- peripheral neuritis in pregnancy (O26.82-)Inherited from G50-G59, G54
- radiculitis NOS (M54.1-)Inherited from G50-G59, G54
- current traumatic nerve root and plexus disorders - see nerve injury by body regionInherited from G50-G59, G54
- intervertebral disc disorders (M50-M51)Inherited from G50-G59, G54
- neuralgia or neuritis NOS (M79.2)Inherited from G50-G59, G54
- neuritis or radiculitis brachial NOS (M54.13)Inherited from G50-G59, G54
- neuritis or radiculitis lumbar NOS (M54.16)Inherited from G50-G59, G54
- neuritis or radiculitis lumbosacral NOS (M54.17)Inherited from G50-G59, G54
- neuritis or radiculitis thoracic NOS (M54.14)Inherited from G50-G59, G54
- radiculitis NOS (M54.10)Inherited from G50-G59, G54
- radiculopathy NOS (M54.10)Inherited from G50-G59, G54
- spondylosis (M47.-)Inherited from G50-G59, G54
Code First
OfficialNo Code First sequencing instructions are included in this display for G54.7. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for G54.7. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for G54.7. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 G54.7 an HCC code?
Yes. G54.7 (Phantom limb syndrome without 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: G54.7 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
- G54.7
- Description
- Phantom limb syndrome without pain
- HCC (V28)
- HCC 409 — Amputation Status, Lower Limb/Amputation Complications
- RAF reference coefficient
- 0.598
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 G54.7 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for G54.7
For G54.7, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
Get the V28 mapping + MEAT cheat sheet
One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
G54.7 is the ICD-10-CM diagnosis code for phantom limb syndrome without pain. A condition where a person feels sensations in a limb that has been amputated or lost, but without pain accompanying those sensations. G54.7 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, G54.7 maps to Amputation Status, Lower Limb/Amputation Complications (HCC 409) with a source-labeled community, non-dual, aged reference coefficient of 0.598. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.
Distinguish from G54.6 (phantom limb syndrome with pain) - this code is specifically for painless phantom sensations. For G54.7, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 G54.7 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish from G54.6 (phantom limb syndrome with pain) - this code is specifically for painless phantom sensations
- •Document which limb is affected if possible, though this code does not require laterality specification
Clinical Significance
Phantom limb syndrome without pain involves non-painful phantom sensations such as perceived movement, itching, pressure, or tingling in an amputated or absent limb. While less distressing than painful phantom limb syndrome, these sensations affect body image, rehabilitation progress, and prosthetic adaptation.
Documentation Requirements
- ✓History of limb amputation or congenital limb absence
- ✓Description of phantom sensations: type (tingling, itching, movement, pressure, temperature, posture awareness)
- ✓Documentation that sensations are NOT painful (distinguishes from G54.6)
- ✓Frequency and impact on daily activities and prosthetic use
- ✓Assessment of body image adaptation and psychological impact
- ✓Any treatment being used for non-painful phantom sensations
- ✓Functional assessment related to prosthetic fitting and use
Commonly Confused Codes
- •G54.6 (Phantom limb syndrome with pain): painful phantom sensations require the WITH pain code for clinical accuracy
- •R20.2 (Paresthesia of skin): generic sensory symptom; phantom limb sensation is specific to absent limb
- •T87.30-T87.9 (Complications of reattached extremity/amputation stump): stump-related issues, not phantom sensations
- •F45.8 (Other somatoform disorders): phantom limb is a neurological phenomenon, not somatoform
- •G54.4 (Lumbosacral root disorders): nerve root pathology, not phantom limb phenomenon