G95.0
BillableSyringomyelia and syringobulbia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G95.0 an HCC code?
Yes. G95.0 maps to Spinal Cord Disorders/Injuries under the CMS-HCC V28 risk adjustment model (and Spinal Cord Disorders/Injuries under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for G95.0
For G95.0to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed G95.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G95.0 is the ICD-10-CM diagnosis code for syringomyelia and syringobulbia. A condition where fluid-filled cavities form within the spinal cord, causing progressive weakness, pain, and loss of temperature sensation. G95.0 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).
Under the CMS-HCC V28 risk adjustment model, G95.0 maps to Spinal Cord Disorders/Injuries (HCC 182) with a community, non-dual, aged base RAF weight of 0.282. Under the older V24 model, G95.0 mapped to the same category but with a base RAF weight of 0.464 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Specify whether the syringomyelia is idiopathic, post-traumatic, or associated with another condition. Because G95.0 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for G95.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify whether the syringomyelia is idiopathic, post-traumatic, or associated with another condition
- •Document the location and extent of the syrinx if available in imaging reports
Clinical Significance
Syringomyelia and syringobulbia are conditions characterized by fluid-filled cavities (syrinx) within the spinal cord or brainstem, respectively, causing progressive neurological deterioration. Syringomyelia typically presents with a distinctive cape-like distribution of pain and temperature sensory loss with preserved light touch (dissociated sensory loss). These conditions require long-term neurosurgical surveillance and management, significantly impacting healthcare resource utilization.
Documentation Requirements
- ✓MRI of the spine demonstrating syrinx cavity with location and extent documented
- ✓Neurological examination findings including dissociated sensory loss, weakness, and muscle atrophy
- ✓Identification of underlying cause (Chiari malformation, post-traumatic, post-inflammatory, tumor-associated)
- ✓Functional impact assessment and disability level
- ✓Surgical treatment history and surveillance plan (shunt status, decompression history)
Commonly Confused Codes
- •G95.20 — Unspecified cord compression: external compression of the spinal cord rather than internal cavity formation
- •G95.11 — Acute infarction of spinal cord: vascular event causing cord damage, not cavitation
- •Q07.0 — Arnold-Chiari syndrome without spina bifida or hydrocephalus: often the underlying cause of syringomyelia, coded separately
- •G95.89 — Other specified diseases of spinal cord: catch-all for cord diseases that does not capture the specificity of syringomyelia