R53.2
BillableFunctional quadriplegia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is R53.2 an HCC code?
Yes. R53.2 maps to Quadriplegia under the CMS-HCC V28 risk adjustment model (and Quadriplegia under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for R53.2
For R53.2 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed R53.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
R53.2 is the ICD-10-CM diagnosis code for functional quadriplegia. Complete inability to move or function independently in all four limbs, though the person is conscious and aware. This represents a severe loss of physical function. R53.2 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).
Under the CMS-HCC V28 risk adjustment model, R53.2 maps to Quadriplegia (HCC 180) with a community, non-dual, aged base RAF weight of 0.274. Under the older V24 model, R53.2 mapped to the same category but with a base RAF weight of 0.885 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This code indicates functional loss rather than true paralysis; verify the patient is conscious and alert. Because R53.2 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R53.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates functional loss rather than true paralysis; verify the patient is conscious and alert
- •Investigate and code the underlying cause (stroke, spinal cord injury, severe illness) when identified
Clinical Significance
Functional quadriplegia represents complete loss of motor function in all four extremities while maintaining consciousness and sensation, indicating severe neurological impairment requiring extensive supportive care. This condition has significant impact on risk adjustment due to the intensive medical management, rehabilitation needs, and high risk of complications associated with immobility.
Documentation Requirements
- ✓Documentation of complete loss of motor function in all extremities
- ✓Preserved consciousness and awareness
- ✓Underlying neurological cause if identified
- ✓Functional assessment and mobility status
- ✓Respiratory function assessment
- ✓Complications of immobility addressed
- ✓Care planning and rehabilitation needs
- ✓Assistive devices and support requirements