R46.0
BillableVery low level of personal hygiene
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is R46.0 an HCC code?
No. R46.0 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
R46.0 is the ICD-10-CM diagnosis code for very low level of personal hygiene. Observable poor personal hygiene, including neglect of bathing, grooming, or cleanliness of clothing and appearance. R46.0 sits in the ICD-10-CM chapter for symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (r00-r99), within the section covering symptoms and signs involving cognition, perception, emotional state and behavior (r40-r46).
R46.0 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.
This code documents observed hygiene status; ensure the provider has documented the specific observations.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R46.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code documents observed hygiene status; ensure the provider has documented the specific observations
- •Consider whether poor hygiene is due to depression, dementia, disability, or other underlying conditions that may warrant additional coding