G82.21
BillableParaplegia, complete
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G82.21 an HCC code?
Yes. G82.21 maps to Paraplegia under the CMS-HCC V28 risk adjustment model (and Paraplegia 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 G82.21
For G82.21 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 G82.21 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G82.21 is the ICD-10-CM diagnosis code for paraplegia, complete. Complete paraplegia is a condition where a person has total loss of function and sensation in both legs due to spinal cord damage or injury. This means the person cannot move or feel their legs and typically requires a wheelchair for mobility. G82.21 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, G82.21 maps to Paraplegia (HCC 181) with a community, non-dual, aged base RAF weight of 0.274. Under the older V24 model, G82.21 mapped to the same category but with a base RAF weight of 0.550 — 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 the documentation specifies 'complete' paraplegia versus 'incomplete' (G82.20) as this distinction is clinically and functionally significant. Because G82.21 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 G82.21 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the documentation specifies 'complete' paraplegia versus 'incomplete' (G82.20) as this distinction is clinically and functionally significant
- •Ensure the underlying cause of paraplegia is documented and coded separately (such as spinal cord injury, trauma, or disease) to provide complete clinical picture
Clinical Significance
Complete paraplegia represents total loss of motor and sensory function in both lower extremities, indicating the most severe form of lower body paralysis. These patients are fully wheelchair-dependent and at high risk for pressure injuries, urinary tract infections, deep vein thrombosis, and autonomic dysreflexia. The resource demands are among the highest in risk adjustment models, and accurate capture is critical for appropriate plan payment.
Documentation Requirements
- ✓Documentation explicitly stating paraplegia is 'complete'
- ✓Verification of total loss of motor AND sensory function below the injury level
- ✓Spinal cord level of injury
- ✓Underlying etiology (traumatic injury, tumor, vascular event, etc.)
- ✓Bladder and bowel management approach
- ✓Skin integrity monitoring and pressure injury prevention
- ✓Wheelchair and adaptive equipment needs
- ✓Active management plan and specialist involvement