G71.0349
BillableLimb girdle muscular dystrophy due to other sarcoglycan dysfunction
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G71.0349 an HCC code?
Yes. G71.0349 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 G71.0349
For G71.0349 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 G71.0349 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G71.0349 is the ICD-10-CM diagnosis code for limb girdle muscular dystrophy due to other sarcoglycan dysfunction. A genetic muscle weakness disorder affecting the hip and shoulder muscles caused by dysfunction of sarcoglycan proteins other than alpha or beta subtypes. G71.0349 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, G71.0349 maps to Muscular Dystrophy (HCC 197) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, G71.0349 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 for gamma, delta, or epsilon sarcoglycan dysfunction when specifically identified. Because G71.0349 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 G71.0349 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for gamma, delta, or epsilon sarcoglycan dysfunction when specifically identified
- •Document which sarcoglycan subtype is affected in the medical record for clarity
Clinical Significance
Limb girdle muscular dystrophy due to other sarcoglycan dysfunction captures gamma-sarcoglycan (LGMD2C), delta-sarcoglycan (LGMD2F), and epsilon-sarcoglycan deficiencies. These rarer sarcoglycanopathies have variable severity but can be as severe as Duchenne muscular dystrophy. Precise identification of the sarcoglycan subtype is important for genetic counseling and emerging gene therapy approaches.
Documentation Requirements
- ✓Genetic testing identifying the specific sarcoglycan mutation (gamma, delta, or epsilon)
- ✓Muscle biopsy showing specific sarcoglycan protein deficiency when available
- ✓Clinical presentation: severity, distribution of weakness, age of onset
- ✓Cardiac and respiratory function assessments
- ✓Documentation specifying which sarcoglycan subtype (other than alpha or beta) is affected
- ✓Family history and inheritance pattern documentation
Commonly Confused Codes
- •G71.0340 — Sarcoglycan dysfunction, unspecified is for when the subtype is completely unknown
- •G71.0341 — Alpha sarcoglycan dysfunction has its own specific code
- •G71.0342 — Beta sarcoglycan dysfunction has its own specific code
- •G71.038 — Other limb girdle muscular dystrophy is for non-sarcoglycan-related limb girdle dystrophies