G90.523 ICD-10-CM Code: Complex regional pain syndrome I of lower limb, bilateral
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Other disorders of the nervous system (G89-G99)
G90.523
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceComplex regional pain syndrome I of lower limb, bilateral
A chronic pain condition affecting both lower limbs (legs) characterized by severe pain, swelling, and changes in skin color or temperature following an injury or illness. The pain is typically disproportionate to the severity of the initial injury.
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
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for G90.523 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G90.523 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G90.523 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G90.523 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G90.523 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G90.523 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G90.523 in this effective period.
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 G90.523 an HCC code?
No. G90.523 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
G90.523 is the ICD-10-CM diagnosis code for complex regional pain syndrome i of lower limb, bilateral. A chronic pain condition affecting both lower limbs (legs) characterized by severe pain, swelling, and changes in skin color or temperature following an injury or illness. The pain is typically disproportionate to the severity of the initial injury. G90.523 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).
G90.523 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.
Verify documentation specifies bilateral involvement of lower limbs; if only one limb is affected, use G90.521 (unilateral) instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G90.523 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies bilateral involvement of lower limbs; if only one limb is affected, use G90.521 (unilateral) instead
- •Ensure the medical record documents the triggering event (injury, surgery, or illness) and confirms CRPS diagnosis; this code requires specificity about laterality and body region