I01
Non-Billable (Header)Rheumatic fever with heart involvement
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
What This Code Means
I01 is the ICD-10-CM diagnosis code for rheumatic fever with heart involvement. I01 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering acute rheumatic fever (i00-i02).
Header codes like I01 cannot be reported on claims directly — they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at I01's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for I01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.