R94.4
BillableAbnormal results of kidney function studies
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is R94.4 an HCC code?
No. R94.4 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
R94.4 is the ICD-10-CM diagnosis code for abnormal results of kidney function studies. Test results showing the kidneys are not functioning normally, such as abnormal findings from kidney function tests or imaging studies. R94.4 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 abnormal findings on diagnostic imaging and in function studies, without diagnosis (r90-r94).
R94.4 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.
Pair with specific kidney disease codes (N18, N19) if chronic kidney disease is diagnosed.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R94.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.