G56.43 ICD-10-CM Code: Causalgia of bilateral upper limbs
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Nerve, nerve root and plexus disorders (G50-G59)
G56.43
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCausalgia of bilateral upper limbs
Causalgia is a severe burning pain that develops after an injury to a nerve, typically in the upper arms or hands on both sides of the body. This condition involves abnormal nerve signaling that causes intense pain, swelling, and changes in skin color or temperature.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Code Book Path
Inclusion Terms
Official- Complex regional pain syndrome II of upper limb
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G56.43 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G56.43 in this effective period.
Excludes 1
Official- complex regional pain syndrome I of lower limb (G90.52-)
- complex regional pain syndrome I of upper limb (G90.51-)
- complex regional pain syndrome II of lower limb (G57.7-)
- reflex sympathetic dystrophy of lower limb (G90.52-)
- reflex sympathetic dystrophy of upper limb (G90.51-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G56.43 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G56.43 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G56.43 in this effective period.
Buddy Documentation Tip
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 G56.43 an HCC code?
No. G56.43 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
G56.43 is the ICD-10-CM diagnosis code for causalgia of bilateral upper limbs. Causalgia is a severe burning pain that develops after an injury to a nerve, typically in the upper arms or hands on both sides of the body. This condition involves abnormal nerve signaling that causes intense pain, swelling, and changes in skin color or temperature. G56.43 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).
G56.43 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Verify that the causalgia affects BOTH upper limbs before assigning this bilateral code; if only one side is affected, use the unilateral code (G56.4-) instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G56.43 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that the causalgia affects BOTH upper limbs before assigning this bilateral code; if only one side is affected, use the unilateral code (G56.4-) instead
- •Document the underlying nerve injury or trauma that triggered the causalgia, as this may require an additional code to fully capture the clinical picture