Question 1

What is ICD-10 code L90.5?

Accepted Answer

L90.5 is the ICD-10-CM diagnosis code for scar conditions and fibrosis of skin. Permanent changes to the skin resulting from healing of wounds or injuries, including scar tissue formation and skin fibrosis that may affect appearance and function. L90.5 sits in the ICD-10-CM chapter for diseases of the skin and subcutaneous tissue (l00-l99), within the section covering other disorders of the skin and subcutaneous tissue (l80-l99).

L90.5 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.

Specify the type of scar (e.g., keloid, contracture, atrophic) if documented, as different scar types may have separate codes.

Question 2

Is L90.5 an HCC code?

Accepted Answer

No. L90.5 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is L90.5 billable?

Accepted Answer

Yes. L90.5 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. L90.5 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for L90.5?

Accepted Answer

L90.5 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards L90.5 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting L90.5?

Accepted Answer

Specify the type of scar (e.g., keloid, contracture, atrophic) if documented, as different scar types may have separate codes Document the location and cause of the scar when available to provide complete clinical picture

HCC Buddy Code Card

L90.5

Is L90.5 an HCC code?

What This Code Means

Coding Tips

Excludes 2, Not included here, may code separately

Child Codes

Code Hierarchy

Open L90.5 in the Interactive Encoder

L90.5 ICD-10-CM Code: Scar conditions and fibrosis of skin

HCC Buddy Code Card

L90.5

Is L90.5 an HCC code?

What This Code Means

Coding Tips

Excludes 2, Not included here, may code separately

Child Codes

Code Hierarchy

Open L90.5 in the Interactive Encoder