L95.1 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupL95.1

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Other disorders of the skin and subcutaneous tissue (L80-L99)

L95.1

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Erythema elevatum diutinum

A chronic inflammatory skin condition featuring persistent, raised red nodules and plaques, typically on the extensor surfaces of joints.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

L95Vasculitis limited to skin, not elsewhere classified L95.1Erythema elevatum diutinum

Inclusion Terms

Official

No inclusion terms are included in this display for L95.1. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from L00-L99
certain infectious and parasitic diseases (A00-B99)Inherited from L00-L99
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from L00-L99
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from L00-L99
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from L00-L99
lipomelanotic reticulosis (I89.8)Inherited from L00-L99
neoplasms (C00-D49)Inherited from L00-L99
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from L00-L99
systemic connective tissue disorders (M30-M36)Inherited from L00-L99
viral warts (B07.-)Inherited from L00-L99

Related Codes

Official

L95.0Livedoid vasculitis L95.8Other vasculitis limited to the skin L95.9Vasculitis limited to the skin, unspecified

Includes

Official

No Includes notes are included in this display for L95.1. Check the code and parent instructions in the Code Book.

Excludes 1

Official

angioma serpiginosum (L81.7)Inherited from L95
Henoch(-Schönlein) purpura (D69.0)Inherited from L95
hypersensitivity angiitis (M31.0)Inherited from L95
lupus panniculitis (L93.2)Inherited from L95
panniculitis NOS (M79.3)Inherited from L95
panniculitis of neck and back (M54.0-)Inherited from L95
polyarteritis nodosa (M30.0)Inherited from L95
relapsing panniculitis (M35.6)Inherited from L95
rheumatoid vasculitis (M05.2)Inherited from L95
serum sickness (T80.6-)Inherited from L95
urticaria (L50.-)Inherited from L95
Wegener's granulomatosis (M31.3-)Inherited from L95

Code First

Official

No Code First sequencing instructions are included in this display for L95.1. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for L95.1. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for L95.1. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

This condition is chronic and recurrent; document the duration and any associated systemic symptoms

Note the distribution pattern (elbows, knees, buttocks) as it aids in diagnosis confirmation

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is L95.1 an HCC code?

No. L95.1 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: L95.1
Description: Erythema elevatum diutinum
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

L95.1 is the ICD-10-CM diagnosis code for erythema elevatum diutinum. A chronic inflammatory skin condition featuring persistent, raised red nodules and plaques, typically on the extensor surfaces of joints. L95.1 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).

L95.1 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

This condition is chronic and recurrent; document the duration and any associated systemic symptoms.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for L95.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This condition is chronic and recurrent; document the duration and any associated systemic symptoms
•Note the distribution pattern (elbows, knees, buttocks) as it aids in diagnosis confirmation