Question 1

What is ICD-10 code G94?

Accepted Answer

G94 is the ICD-10-CM diagnosis code for other disorders of brain in diseases classified elsewhere. Brain disorders that occur as a result of another disease classified elsewhere, such as brain involvement in systemic infections or metabolic disorders. G94 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).

G94 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.

This code requires a secondary code to identify the underlying disease causing the brain disorder.

Question 2

Is G94 an HCC code?

Accepted Answer

No. G94 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is G94 billable?

Accepted Answer

Yes. G94 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. G94 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for G94?

Accepted Answer

G94 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards G94 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting G94?

Accepted Answer

This code requires a secondary code to identify the underlying disease causing the brain disorder Use the 'in diseases classified elsewhere' convention; code the primary condition first

G94

Is G94 an HCC code?

What This Code Means

Coding Tips

Excludes 1 — Do NOT code together

Code First

Code Hierarchy

Open G94 in the Interactive Encoder