L12.1 ICD-10-CM Code: Cicatricial pemphigoid
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Bullous disorders (L10-L14)
L12.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCicatricial pemphigoid
An autoimmune blistering disease that primarily affects the mucous membranes and can lead to scarring and permanent damage if untreated.
Buddy Insight
Cicatricial pemphigoid is a scarring autoimmune blistering disease primarily affecting mucous membranes, potentially causing blindness or airway compromise.
CMS-HCC V28
MappedHCC 387
RAF 0.262
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
MappedHCC 314
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Benign mucous membrane pemphigoid
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for L12.1 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for L12.1 in this effective period.
Excludes 1
Official- herpes gestationis (O26.4-)
- impetigo herpetiformis (L40.1)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for L12.1 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for L12.1 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for L12.1 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 L12.1 an HCC code?
Yes. L12.1 maps to Pemphigus and Other Autoimmune Skin Conditions under the CMS-HCC V28 risk adjustment model.
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 L12.1
For L12.1to 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 L12.1 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
L12.1 is the ICD-10-CM diagnosis code for cicatricial pemphigoid. An autoimmune blistering disease that primarily affects the mucous membranes and can lead to scarring and permanent damage if untreated. L12.1 sits in the ICD-10-CM chapter for diseases of the skin and subcutaneous tissue (l00-l99), within the section covering bullous disorders (l10-l14).
Under the CMS-HCC V28 risk adjustment model, L12.1 maps to Pemphigus and Other Autoimmune Skin Conditions (HCC 387) with a community, non-dual, aged base RAF weight of 0.262. L12.1 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. 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.
This condition often requires long-term management and monitoring for complications. Because L12.1 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 L12.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This condition often requires long-term management and monitoring for complications
- •Document the location and extent of involvement (oral, ocular, laryngeal, etc.) for comprehensive coding
Clinical Significance
Cicatricial pemphigoid is a scarring autoimmune blistering disease primarily affecting mucous membranes, potentially causing blindness or airway compromise. This diagnosis represents a serious condition requiring aggressive treatment to prevent permanent disability.
Documentation Requirements
- ✓Predominant mucosal involvement (oral, ocular, genital)
- ✓Evidence of scarring or cicatrization
- ✓Histopathologic subepidermal blistering
- ✓Direct immunofluorescence with basement membrane deposits
- ✓Ophthalmologic evaluation when eyes involved
- ✓Assessment for airway involvement
- ✓Multidisciplinary treatment approach
- ✓Monitoring for progressive scarring