Question 1

What is ICD-10 code R52?

Accepted Answer

R52 is the ICD-10-CM diagnosis code for Pain, unspecified. Pain that is not specified to a particular location or cause. This is used when the type or source of pain is not documented or identified. R52 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. R52 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Question 2

Is R52 an HCC code?

Accepted Answer

No. R52 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 R52 billable?

Accepted Answer

Yes. R52 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. R52 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

What is the V28 vs V24 difference for R52?

Accepted Answer

R52 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 model rewards R52 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting R52?

Accepted Answer

Use this code only when the pain location or type cannot be determined from documentation If pain is localized to a specific body part or has an identified cause, use a more specific pain code instead

R52

Is R52 an HCC code?

What This Code Means

Coding Tips

Excludes 1 — Do NOT code together

Code Hierarchy

Open R52 in the Interactive Encoder