G71.0340
BillableLimb girdle muscular dystrophy due to sarcoglycan dysfunction, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G71.0340 an HCC code?
Yes. G71.0340 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 G71.0340
For G71.0340 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 G71.0340 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G71.0340 is the ICD-10-CM diagnosis code for limb girdle muscular dystrophy due to sarcoglycan dysfunction, unspecified. A genetic muscle weakness disorder affecting the hip and shoulder muscles caused by sarcoglycan protein dysfunction, but the specific type of sarcoglycan affected is not specified. G71.0340 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, G71.0340 maps to Muscular Dystrophy (HCC 197) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, G71.0340 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.
Use this code only when sarcoglycan dysfunction is confirmed but the specific subtype cannot be determined. Because G71.0340 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 G71.0340 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when sarcoglycan dysfunction is confirmed but the specific subtype cannot be determined
- •Encourage providers to obtain genetic testing to identify the specific sarcoglycan type for more precise coding
Clinical Significance
Limb girdle muscular dystrophy due to sarcoglycan dysfunction, unspecified represents a group of autosomal recessive muscular dystrophies caused by deficiency of sarcoglycan proteins, which form part of the dystrophin-associated glycoprotein complex. These sarcoglycanopathies can be clinically severe, sometimes mimicking Duchenne muscular dystrophy. Proper coding supports genetic subtyping efforts and treatment planning.
Documentation Requirements
- ✓Muscle biopsy or genetic testing confirming sarcoglycan protein deficiency
- ✓Clinical presentation: progressive proximal weakness, elevated creatine kinase
- ✓Documentation that the specific sarcoglycan subtype (alpha, beta, gamma, delta) could not be determined
- ✓Cardiac evaluation results (sarcoglycanopathies can cause cardiomyopathy)
- ✓Functional status and disease progression
- ✓Provider's explicit diagnosis of sarcoglycan-related limb girdle muscular dystrophy