HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Other disorders of the nervous system (G89-G99)
G89.4
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceChronic pain syndrome
A condition characterized by persistent pain lasting longer than normal healing time, often accompanied by physical and emotional symptoms that significantly impact daily functioning.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Chronic pain associated with significant psychosocial dysfunction
Excludes 2
Official- atypical face pain (G50.1)
- headache syndromes (G44.-)
- localized pain, unspecified type - code to pain by site, such as:
- abdomen pain (R10.-)
- back pain (M54.9)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G89.4 in this effective period.
Excludes 1
Official- generalized pain NOS (R52)
- pain disorders exclusively related to psychological factors (F45.41)
- pain NOS (R52)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G89.4 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G89.4 in this effective period.
Code Also
Official- related psychological factors associated with pain (F45.42)
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is G89.4 an HCC code?
No. G89.4 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
G89.4 is the ICD-10-CM diagnosis code for chronic pain syndrome. A condition characterized by persistent pain lasting longer than normal healing time, often accompanied by physical and emotional symptoms that significantly impact daily functioning. G89.4 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering other disorders of the nervous system (g89-g99).
G89.4 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Specify the site of pain with an additional code when documented.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G89.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.