G81.01
BillableFlaccid hemiplegia affecting right dominant side
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G81.01 an HCC code?
Yes. G81.01 maps to Hemiplegia/Hemiparesis under the CMS-HCC V28 risk adjustment model (and Hemiplegia/Hemiparesis 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 G81.01
For G81.01to 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 G81.01 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G81.01 is the ICD-10-CM diagnosis code for flaccid hemiplegia affecting right dominant side. Weakness or paralysis affecting the right side of the body with floppy, loose muscle tone in a right-handed person. G81.01 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering cerebral palsy and other paralytic syndromes (g80-g83).
Under the CMS-HCC V28 risk adjustment model, G81.01 maps to Hemiplegia/Hemiparesis (HCC 253) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, G81.01 mapped to the same category but with a base RAF weight of 0.447 — 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.
Ensure documentation specifies both the side affected (right) and dominance (dominant) for accurate coding. Because G81.01 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 G81.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation specifies both the side affected (right) and dominance (dominant) for accurate coding
- •Common after stroke; review acute care records for onset and etiology
Clinical Significance
Flaccid hemiplegia affecting the right dominant side represents one of the most functionally debilitating presentations, as the patient loses tone and function in their primary hand and dominant extremities. This dramatically impacts writing, feeding, dressing, and most daily activities. The specificity of this code — identifying both the flaccid type and dominant side involvement — reflects documentation quality that supports accurate risk adjustment.
Documentation Requirements
- ✓Documentation of hemiplegia specifically described as flaccid (low muscle tone)
- ✓Right side specified as the affected side
- ✓Dominance documented (right-handed or right-dominant)
- ✓Underlying cause documented and coded separately
- ✓Neurological examination findings supporting flaccid presentation
- ✓Functional status and impact on activities of daily living
- ✓Active treatment plan including rehabilitation services
Commonly Confused Codes
- •G81.03 Flaccid hemiplegia affecting right nondominant side — right side affected but in a left-handed person
- •G81.11 Spastic hemiplegia affecting right dominant side — same laterality/dominance but spastic rather than flaccid tone
- •G81.91 Hemiplegia, unspecified affecting right dominant side — use when tone type is not documented
- •I69.051 Hemiplegia following cerebrovascular disease, right dominant — use when directly attributable to stroke sequelae