G96.811 ICD-10-CM Code: Intracranial hypotension, spontaneous
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)
G96.811
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceIntracranial hypotension, spontaneous
Low pressure in the fluid surrounding the brain and spinal cord that occurs spontaneously without an identifiable external cause.
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
OfficialICD-10-CM does not list inclusion terms for G96.811 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G96.811 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G96.811 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G96.811 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G96.811 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G96.811 in this effective period.
Code Also
Official- any associated diagnoses, such as:
- Brachial amyotrophy (G54.5)
- Cerebrospinal fluid leak from spine (G96.02)
- Cranial nerve disorders in diseases classified elsewhere (G53)
- Nerve root and compressions in diseases classified elsewhere (G55)
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 G96.811 an HCC code?
No. G96.811 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
G96.811 is the ICD-10-CM diagnosis code for intracranial hypotension, spontaneous. Low pressure in the fluid surrounding the brain and spinal cord that occurs spontaneously without an identifiable external cause. G96.811 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).
G96.811 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.
Document that the condition is spontaneous and not related to procedures or trauma.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G96.811 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document that the condition is spontaneous and not related to procedures or trauma
- •This code is more specific than G96.810 and should be used when spontaneous etiology is confirmed