N97.1
BillableFemale infertility of tubal origin
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
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.
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