G71.0342
BillableLimb girdle muscular dystrophy due to beta sarcoglycan dysfunction
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G71.0342 an HCC code?
Yes. G71.0342 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 G71.0342
For G71.0342 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 G71.0342 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G71.0342 is the ICD-10-CM diagnosis code for limb girdle muscular dystrophy due to beta sarcoglycan dysfunction. A genetic muscle weakness disorder affecting the hip and shoulder muscles caused by dysfunction of beta sarcoglycan, a protein component of the muscle cell membrane. G71.0342 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, G71.0342 maps to Muscular Dystrophy (HCC 197) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, G71.0342 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.
Verify beta sarcoglycan gene mutation through genetic testing before assigning this specific code. Because G71.0342 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 G71.0342 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify beta sarcoglycan gene mutation through genetic testing before assigning this specific code
- •Note that beta sarcoglycan deficiency typically follows autosomal recessive inheritance
Clinical Significance
Limb girdle muscular dystrophy due to beta sarcoglycan dysfunction (LGMD2E/LGMDR4) is a severe form of sarcoglycanopathy with high risk of cardiac involvement. Beta-sarcoglycan deficiency can cause both skeletal muscle weakness and dilated cardiomyopathy. Accurate coding supports appropriate cardiac monitoring protocols and reflects the dual burden of skeletal and cardiac muscle disease.
Documentation Requirements
- ✓Genetic testing confirming SGCB gene mutation or muscle biopsy showing absent/reduced beta-sarcoglycan
- ✓Clinical presentation: progressive proximal weakness with possible cardiac involvement
- ✓Cardiac evaluation results: echocardiogram, cardiac MRI when available
- ✓Respiratory function assessment
- ✓Autosomal recessive inheritance pattern documentation
- ✓Provider's explicit diagnosis specifying beta sarcoglycan dysfunction