G83.5 ICD-10-CM Code: Locked-in state
G83.5 maps to CMS-HCC V28 254. 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)
G83.5
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLocked-in state
A rare neurological condition where a person is completely paralyzed but remains conscious and aware, unable to move or speak but able to think and perceive.
Buddy Insight
Locked-in state is a devastating neurological condition typically caused by basilar artery occlusion or pontine hemorrhage, where the patient is fully conscious and aware but completely paralyzed except for vertical eye movements and blinking.
CMS-HCC V28
MappedHCC 254
Coefficient HCC 254: 0.321 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 122
Code-level coefficient reference
ESRD/PACE
MappedHCC 104
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for G83.5. 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
Official- paralysis (complete) (incomplete), except as in G80-G82Inherited from G83
Excludes 1
OfficialNo Excludes 1 notes are included in this display for G83.5. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for G83.5. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for G83.5. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for G83.5. 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 G83.5 an HCC code?
Yes. G83.5 (Locked-in state) maps to HCC 254, Monoplegia, Other Paralytic Syndromes under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.321. 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: G83.5 is billable and maps to V28 HCC 254, Monoplegia, Other Paralytic Syndromes. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- G83.5
- Description
- Locked-in state
- HCC (V28)
- HCC 254 — Monoplegia, Other Paralytic Syndromes
- RAF reference coefficient
- 0.321
- 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 G83.5 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for G83.5
For G83.5, 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
G83.5 is the ICD-10-CM diagnosis code for locked-in state. A rare neurological condition where a person is completely paralyzed but remains conscious and aware, unable to move or speak but able to think and perceive. G83.5 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, G83.5 maps to Monoplegia, Other Paralytic Syndromes (HCC 254) with a source-labeled community, non-dual, aged reference coefficient of 0.321. 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.
This code requires careful documentation to distinguish from coma or vegetative states. For G83.5, 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 G83.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code requires careful documentation to distinguish from coma or vegetative states
- •Document the underlying cause (stroke, trauma, disease) separately for complete clinical picture
Clinical Significance
Locked-in state is a devastating neurological condition typically caused by basilar artery occlusion or pontine hemorrhage, where the patient is fully conscious and aware but completely paralyzed except for vertical eye movements and blinking. These patients require total care including ventilator support, nutritional management, and comprehensive medical oversight. This is one of the most resource-intensive conditions in neurology, and proper coding is essential for care planning.
Documentation Requirements
- ✓Explicit documentation of locked-in state/syndrome
- ✓Distinction from coma, persistent vegetative state, or brain death
- ✓Documentation of preserved consciousness and awareness (eye tracking, communication via blinks)
- ✓Underlying etiology (basilar artery stroke, pontine hemorrhage, demyelination, etc.)
- ✓Ventilator and nutritional support status
- ✓Communication method (eye blinks, specialized devices)
- ✓Total care dependency documentation
- ✓Active comprehensive management plan
Commonly Confused Codes
- •R40.20 Unspecified coma: patient is unconscious; locked-in patient is conscious
- •G82.50 Quadriplegia, unspecified: quadriplegia without the specific pontine syndrome
- •G93.1 Anoxic brain damage: diffuse brain injury, different mechanism
- •R40.4 Transient alteration of awareness: temporary condition, unlike locked-in state
- •G83.89 Other specified paralytic syndromes: less specific paralysis code