Question 1

What is ICD-10 code N62?

Accepted Answer

N62 is the ICD-10-CM diagnosis code for hypertrophy of breast. Abnormal enlargement of one or both breasts, which may be caused by hormonal changes, medications, or other factors. This is a benign condition but may cause physical discomfort. N62 sits in the ICD-10-CM chapter for diseases of the genitourinary system (n00-n99), within the section covering disorders of breast (n60-n65).

N62 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.

Document laterality (unilateral or bilateral) and any associated symptoms such as pain or tenderness.

Question 2

Is N62 an HCC code?

Accepted Answer

No. N62 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 N62 billable?

Accepted Answer

Yes. N62 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. N62 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

Which HCC does N62 map to under V28?

Accepted Answer

N62 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does N62 pay in RAF?

Accepted Answer

N62 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for N62?

Accepted Answer

N62 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 community model rewards N62 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports N62?

Accepted Answer

Document laterality (unilateral or bilateral) and any associated symptoms such as pain or tenderness Distinguish from gynecomastia (male breast enlargement) which has separate coding; N62 is typically used for female breast hypertrophy N62 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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N62

Is N62 an HCC code?

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What This Code Means

Coding Tips

Excludes 1, Do NOT code together

Code Hierarchy

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N62 ICD-10-CM Code: Hypertrophy of breast

HCC Buddy Code Card

N62

Is N62 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Excludes 1, Do NOT code together

Code Hierarchy

Work N62 in HCC Buddy