Question 1

What is ICD-10 code Z52.813?

Accepted Answer

Z52.813 is the ICD-10-CM diagnosis code for egg (oocyte) donor age 35 and over, designated recipient. A woman age 35 or older who is donating eggs (oocytes) for fertility treatment where the recipient is known or identified to the donor. Z52.813 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering encounters for other specific health care (z40-z53).

Z52.813 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.

Document the specific age of the donor when possible, as this impacts fertility counseling and outcomes.

Question 2

Is Z52.813 an HCC code?

Accepted Answer

No. Z52.813 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 Z52.813 billable?

Accepted Answer

Yes. Z52.813 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. Z52.813 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 Z52.813?

Accepted Answer

Z52.813 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 Z52.813 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 Z52.813?

Accepted Answer

Document the specific age of the donor when possible, as this impacts fertility counseling and outcomes Confirm whether the recipient relationship is designated before assigning this code

HCC Buddy Code Card

Z52.813

Is Z52.813 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open Z52.813 in the Interactive Encoder

Z52.813 ICD-10-CM Code: Egg (Oocyte) donor age 35 and over, designated recipient

HCC Buddy Code Card

Z52.813

Is Z52.813 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open Z52.813 in the Interactive Encoder