G71.01
BillableDuchenne or Becker muscular dystrophy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G71.01 an HCC code?
Yes. G71.01 maps to Muscular Dystrophy under the CMS-HCC V28 risk adjustment model (and Muscular Dystrophy 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 G71.01
For G71.01 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 G71.01 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G71.01 is the ICD-10-CM diagnosis code for duchenne or becker muscular dystrophy. A severe inherited muscle disease causing progressive weakness and wasting, with Duchenne type being more severe and Becker type being milder. G71.01 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering diseases of myoneural junction and muscle (g70-g73).
Under the CMS-HCC V28 risk adjustment model, G71.01 maps to Muscular Dystrophy (HCC 197) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, G71.01 mapped to the same category but with a base RAF weight of 0.358 — 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.
Specify whether Duchenne or Becker type when documentation permits; these have different severity and prognosis. Because G71.01 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 G71.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify whether Duchenne or Becker type when documentation permits; these have different severity and prognosis
- •Document age of onset and progression pattern to support the diagnosis
Clinical Significance
Duchenne or Becker muscular dystrophy are X-linked recessive dystrophinopathies representing the most common and among the most severe forms of muscular dystrophy. Duchenne type has childhood onset with loss of ambulation by adolescence and life-threatening cardiac and respiratory complications. Accurate coding is critical for capturing the extraordinary care complexity including corticosteroids, cardiac monitoring, respiratory support, and mobility aids.
Documentation Requirements
- ✓Genetic testing confirming dystrophin gene mutation or muscle biopsy showing absent/reduced dystrophin
- ✓Specification of Duchenne versus Becker type when possible (Duchenne has absent dystrophin, Becker has reduced)
- ✓Age of onset and progression timeline
- ✓Current functional status: ambulatory versus non-ambulatory, respiratory function
- ✓Cardiac evaluation: echocardiogram results, cardiac involvement
- ✓Current treatment: corticosteroids, cardiac medications, respiratory support