N97.9 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupN97.9

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the genitourinary system (N00-N99) / Noninflammatory disorders of female genital tract (N80-N98)

N97.9

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

Female infertility, unspecified

A woman's inability to become pregnant when the specific cause has not been identified or documented.

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

N97Female infertility N97.9Female infertility, unspecified

Inclusion Terms

Official

No inclusion terms are included in this display for N97.9. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from N00-N99, N97
certain infectious and parasitic diseases (A00-B99)Inherited from N00-N99, N97
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from N00-N99, N97
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from N00-N99, N97
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from N00-N99, N97
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from N00-N99, N97
neoplasms (C00-D49)Inherited from N00-N99, N97
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from N00-N99, N97
female infertility associated with:Inherited from N00-N99, N97
hypopituitarism (E23.0)Inherited from N00-N99, N97
Stein-Leventhal syndrome (E28.2)Inherited from N00-N99, N97
incompetence of cervix uteri (N88.3)Inherited from N00-N99, N97

Related Codes

Official

N97.0Female infertility associated with anovulation N97.1Female infertility of tubal origin N97.2Female infertility of uterine origin N97.8Female infertility of other origin

Includes

Official

inability to achieve a pregnancyInherited from N97
sterility, female NOSInherited from N97

Excludes 1

Official

No Excludes 1 notes are included in this display for N97.9. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for N97.9. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for N97.9. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for N97.9. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

This is a default code; use only when the cause of infertility is truly unspecified or not yet determined

Query the provider if diagnostic workup results are available to assign a more specific code

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 N97.9 an HCC code?

No. N97.9 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: N97.9
Description: Female infertility, unspecified
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

N97.9 is the ICD-10-CM diagnosis code for female infertility, unspecified. A woman's inability to become pregnant when the specific cause has not been identified or documented. N97.9 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).

N97.9 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 is a default code; use only when the cause of infertility is truly unspecified or not yet determined.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for N97.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is a default code; use only when the cause of infertility is truly unspecified or not yet determined
•Query the provider if diagnostic workup results are available to assign a more specific code