N97.1 ICD-10-CM Code: Female infertility of tubal origin
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FY 2026 Apr update / Diseases of the genitourinary system (N00-N99) / Noninflammatory disorders of female genital tract (N80-N98)
N97.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceFemale infertility of tubal origin
A woman's inability to become pregnant due to problems with the fallopian tubes, such as blockage, scarring, or damage that prevents eggs from traveling properly.
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
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Female infertility associated with congenital anomaly of tube
- Female infertility due to tubal block
- Female infertility due to tubal occlusion
- Female infertility due to tubal stenosis
Excludes 2
Official- female infertility associated with:
- hypopituitarism (E23.0)
- Stein-Leventhal syndrome (E28.2)
- incompetence of cervix uteri (N88.3)
Related Child Codes
Includes
Official- inability to achieve a pregnancy
- sterility, female NOS
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for N97.1 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for N97.1 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for N97.1 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for N97.1 in this effective period.
Buddy Documentation Tip
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 N97.1 an HCC code?
No. N97.1 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- N97.1
- Description
- Female infertility of tubal origin
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
N97.1 is the ICD-10-CM diagnosis code for female infertility of tubal origin. A woman's inability to become pregnant due to problems with the fallopian tubes, such as blockage, scarring, or damage that prevents eggs from traveling properly. N97.1 sits in the ICD-10-CM chapter for diseases of the genitourinary system (n00-n99), within the section covering noninflammatory disorders of female genital tract (n80-n98).
N97.1 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.
Verify documentation specifies tubal pathology (blockage, adhesions, stricture) before assigning this code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for N97.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies tubal pathology (blockage, adhesions, stricture) before assigning this code
- •Do not use this code if infertility is due to other causes; ensure tubal origin is clearly documented