R53.1
BillableWeakness
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is R53.1 an HCC code?
No. R53.1 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
R53.1 is the ICD-10-CM diagnosis code for weakness. A general feeling of physical weakness or lack of strength without a specific cause identified. The person may have difficulty performing normal activities. R53.1 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 general symptoms and signs (r50-r69).
R53.1 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.
Distinguish between generalized weakness and weakness affecting specific body parts or muscles.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R53.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish between generalized weakness and weakness affecting specific body parts or muscles
- •If weakness is related to a specific condition (stroke, neuropathy), code the underlying condition as well