G82.54 ICD-10-CM Code: Quadriplegia, C5-C7 incomplete
G82.54 maps to CMS-HCC V28 180. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Cerebral palsy and other paralytic syndromes (G80-G83)
G82.54
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceQuadriplegia, C5-C7 incomplete
Partial paralysis of all four limbs resulting from injury to the lower cervical spinal cord (C5-C7 vertebrae level), with some preservation of motor or sensory function below the injury.
Buddy Insight
Incomplete quadriplegia at the C5-C7 level represents the most favorable prognosis among quadriplegia diagnoses, with preserved function at a lower cervical level allowing for greater independence in self-care, mobility, and potentially even modified driving.
CMS-HCC V28
MappedHCC 180
Coefficient HCC 180: 1.125 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 107
Code-level coefficient reference
ESRD/PACE
MappedHCC 70
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for G82.54. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from G00-G99
- certain infectious and parasitic diseases (A00-B99)Inherited from G00-G99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from G00-G99
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from G00-G99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from G00-G99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from G00-G99
- neoplasms (C00-D49)Inherited from G00-G99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from G00-G99
Related Codes
Includes
OfficialNo Includes notes are included in this display for G82.54. Check the code and parent instructions in the Code Book.
Excludes 1
Official- congenital cerebral palsy (G80.-)Inherited from G82
- functional quadriplegia (R53.2)Inherited from G82
- hysterical paralysis (F44.4)Inherited from G82
Code First
OfficialNo Code First sequencing instructions are included in this display for G82.54. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for G82.54. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for G82.54. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is G82.54 an HCC code?
Yes. G82.54 (Quadriplegia, C5-C7 incomplete) maps to HCC 180, Quadriplegia under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 1.125. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: G82.54 is billable and maps to V28 HCC 180, Quadriplegia. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- G82.54
- Description
- Quadriplegia, C5-C7 incomplete
- HCC (V28)
- HCC 180 — Quadriplegia
- RAF reference coefficient
- 1.125
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work G82.54 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for G82.54
For G82.54, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
G82.54 is the ICD-10-CM diagnosis code for quadriplegia, c5-c7 incomplete. Partial paralysis of all four limbs resulting from injury to the lower cervical spinal cord (C5-C7 vertebrae level), with some preservation of motor or sensory function below the injury. G82.54 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, G82.54 maps to Quadriplegia (HCC 180) with a source-labeled community, non-dual, aged reference coefficient of 1.125. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Incomplete quadriplegia at C5-C7 level generally has better functional prognosis than complete injuries at the same level. For G82.54, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for G82.54 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Incomplete quadriplegia at C5-C7 level generally has better functional prognosis than complete injuries at the same level
- •Ensure documentation supports both the C5-C7 level and incomplete status before coding
Clinical Significance
Incomplete quadriplegia at the C5-C7 level represents the most favorable prognosis among quadriplegia diagnoses, with preserved function at a lower cervical level allowing for greater independence in self-care, mobility, and potentially even modified driving. Rehabilitation potential is highest in this category, and patients may achieve significant functional gains with intensive therapy. Distinguishing this from other quadriplegia levels is essential for appropriate goal-setting.
Documentation Requirements
- ✓Documentation specifying C5-C7 level with incomplete quadriplegia
- ✓Description of preserved motor and sensory function
- ✓Neurological assessment details (ASIA classification if available)
- ✓Underlying etiology
- ✓Functional assessment and independence level
- ✓Rehabilitation progress and goals
- ✓Active treatment plan
- ✓Equipment and assistive device needs
Commonly Confused Codes
- •G82.53 Quadriplegia, C5-C7 complete: no preserved function at this level
- •G82.52 Quadriplegia, C1-C4 incomplete: higher level with typically more severe deficits
- •G82.50 Quadriplegia, unspecified: use when neither level nor completeness is documented
- •G82.22 Paraplegia, incomplete: only lower extremities affected