R57.1
BillableHypovolemic shock
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is R57.1 an HCC code?
Yes. R57.1 maps to Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock under the CMS-HCC V28 risk adjustment model (and Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock 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 R57.1
For R57.1 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 R57.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
R57.1 is the ICD-10-CM diagnosis code for hypovolemic shock. A life-threatening condition caused by severe loss of blood or body fluids, resulting in insufficient blood volume to maintain circulation and blood pressure. R57.1 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).
Under the CMS-HCC V28 risk adjustment model, R57.1 maps to Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock (HCC 2) with a community, non-dual, aged base RAF weight of 0.455. The V24 model used during the PY2024–PY2025 transition mapped R57.1 the same way and at the same RAF weight. 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.
Document the source of fluid loss (hemorrhage, burns, dehydration) and code the underlying cause separately. Because R57.1 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 R57.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the source of fluid loss (hemorrhage, burns, dehydration) and code the underlying cause separately
- •Ensure documentation specifies hypovolemic shock rather than other shock types
Clinical Significance
Hypovolemic shock results from severe intravascular volume loss leading to inadequate tissue perfusion and hemodynamic instability. This life-threatening condition requires immediate fluid resuscitation and identification of the bleeding or fluid loss source, with significant impact on risk adjustment due to high mortality risk and intensive care requirements.
Documentation Requirements
- ✓Documentation of shock due to volume loss
- ✓Evidence of significant fluid or blood loss
- ✓Hemodynamic instability (hypotension, tachycardia)
- ✓Signs of poor tissue perfusion
- ✓Source of volume loss identified if possible
- ✓Response to fluid resuscitation
- ✓Blood product transfusion if indicated
- ✓Surgical intervention for bleeding control