M80.80XA ICD-10-CM Code: Other osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
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 musculoskeletal system and connective tissue (M00-M99) / Disorders of bone density and structure (M80-M85)
M80.80XA
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
Other osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 87
RAF 0.055
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for M80.80XA in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M80.80XA in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M80.80XA in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M80.80XA in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M80.80XA in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M80.80XA in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M80.80XA in this effective period.
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 M80.80XA an HCC code?
M80.80XA is not in the CMS-HCC V28 or V24 community payment model, but it does map to Osteoporosis, Vertebral and Pathological Fractures under the Part D RxHCC model.
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.
Work M80.80XA in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for M80.80XA
For M80.80XAto 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 M80.80XA during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
Get the V28 RAF + MEAT cheat sheet
One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
M80.80XA is the ICD-10-CM diagnosis code for other osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture. M80.80XA sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering disorders of bone density and structure (m80-m85).
M80.80XA 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.
M80.80XA is a billable ICD-10-CM code that can be reported on claims but does not currently contribute to a Medicare Advantage member's RAF score under any CMS risk adjustment model (V28, V24, ESRD, or RxHCC). Coders reviewing M80.80XA should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M80.80XA sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.