G95.19
BillableOther vascular myelopathies
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G95.19 an HCC code?
Yes. G95.19 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 G95.19
For G95.19 to 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 G95.19 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G95.19 is the ICD-10-CM diagnosis code for other vascular myelopathies. This code describes damage to the spinal cord caused by blood vessel problems other than the common types (like spinal cord infarction or hemorrhage). These vascular issues can reduce blood flow to the spinal cord, leading to weakness, numbness, or loss of function. G95.19 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, G95.19 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, G95.19 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.
Use this code only when the vascular myelopathy doesn't fit into more specific categories like G95.11 (infarction) or G95.12 (hemorrhage); always document the underlying vascular condition if known. Because G95.19 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 G95.19 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the vascular myelopathy doesn't fit into more specific categories like G95.11 (infarction) or G95.12 (hemorrhage); always document the underlying vascular condition if known
- •Verify documentation clearly indicates a vascular cause of the spinal cord dysfunction; coordinate with the physician if the etiology is unclear to ensure accurate code selection
Clinical Significance
Other vascular myelopathies encompass non-infarction vascular conditions affecting the spinal cord, including venous congestion myelopathy, spinal dural arteriovenous fistula-related myelopathy, and subacute or chronic ischemic cord conditions. These conditions may present insidiously with progressive weakness and sensory changes. Identification is important because some forms (particularly dural arteriovenous fistulas) are surgically treatable.
Documentation Requirements
- ✓MRI demonstrating spinal cord signal abnormality consistent with vascular pathology
- ✓Spinal angiography results if performed, identifying any vascular malformation
- ✓Clinical documentation of progressive neurological symptoms and their vascular etiology
- ✓Differentiation from acute spinal cord infarction (which has its own code G95.11)
- ✓Treatment plan including any endovascular or surgical intervention
Commonly Confused Codes
- •G95.11 — Acute infarction of spinal cord: use for acute vascular events with sudden onset
- •G95.0 — Syringomyelia: non-vascular cavity formation within the cord
- •G95.89 — Other specified diseases of spinal cord: non-vascular specified cord pathology
- •I67.1 — Cerebral aneurysm, nonruptured: intracranial vascular lesion, not spinal