Z53.1 ICD-10-CM Code: Procedure and treatment not carried out because of patient's decision for reasons of belief and group pressure
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FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Encounters for other specific health care (Z40-Z53)
Z53.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceProcedure and treatment not carried out because of patient's decision for reasons of belief and group pressure
A planned medical procedure or treatment was not performed because the patient refused it based on their personal beliefs, religious convictions, or pressure from family or community members.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for Z53.1 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Z53.1 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Z53.1 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for Z53.1 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Z53.1 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Z53.1 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Z53.1 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is Z53.1 an HCC code?
No. Z53.1 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
Z53.1 is the ICD-10-CM diagnosis code for procedure and treatment not carried out because of patient's decision for reasons of belief and group pressure. A planned medical procedure or treatment was not performed because the patient refused it based on their personal beliefs, religious convictions, or pressure from family or community members. Z53.1 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).
Z53.1 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.
This code captures refusals based on belief systems, religion, or social/family pressure rather than medical reasons.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z53.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code captures refusals based on belief systems, religion, or social/family pressure rather than medical reasons
- •Document the patient's stated reason for refusal in the medical record for continuity of care