Z68.45 ICD-10-CM Code: Body mass index [BMI] 70 or greater, adult
Z68.45 maps to CMS-HCC V28 48 (RAF 0.186). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools
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FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Body mass index [BMI] (Z68)
Z68.45
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBody mass index [BMI] 70 or greater, adult
A measurement of body weight relative to height (BMI) of 70 or greater in adults, indicating severe obesity.
Buddy Insight
This code indicates the most severe level of obesity with BMI 70 or greater, representing extreme health risk requiring immediate intensive medical management and urgent surgical intervention.
CMS-HCC V28
MappedHCC 48
RAF 0.186
CMS-HCC V24
MappedHCC 22
RAF 0.250
ACA/HHS
N/A—
Not mapped
ESRD/PACE
MappedHCC 22
RAF 0.081
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for Z68.45 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Z68.45 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Z68.45 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for Z68.45 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Z68.45 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Z68.45 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Z68.45 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is Z68.45 an HCC code?
Yes. Z68.45 (Body mass index [BMI] 70 or greater, adult) maps to Morbid Obesity under the CMS-HCC V28 risk adjustment model (and Morbid Obesity under V24), with a community non-dual aged RAF of 0.186. It is billable for payment year 2026.
Coder answer: Z68.45 is billable and maps to V28 HCC 48, Morbid Obesity. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- Z68.45
- Description
- Body mass index [BMI] 70 or greater, adult
- HCC (V28)
- HCC 48 — Morbid Obesity
- RAF
- 0.186
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.
Work Z68.45 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for Z68.45
For Z68.45 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 Z68.45 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
Z68.45 is the ICD-10-CM diagnosis code for body mass index [bmi] 70 or greater, adult. A measurement of body weight relative to height (BMI) of 70 or greater in adults, indicating severe obesity. Z68.45 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering body mass index [bmi] (z68).
Under the CMS-HCC V28 risk adjustment model, Z68.45 maps to Morbid Obesity (HCC 48) with a community, non-dual, aged base RAF weight of 0.186. Under the older V24 model, Z68.45 mapped to the same category but with a base RAF weight of 0.250, 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.
BMI 70 or greater, adult, the highest BMI category. Pair with E66.01 or E66.2 and consider E66.2 if hypoventilation is also documented. Because Z68.45 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 Z68.45 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •BMI 70 or greater, adult, the highest BMI category. Pair with E66.01 or E66.2 and consider E66.2 if hypoventilation is also documented.
- •Do not report Z68.45 without the E66 pairing. Although the BMI code maps to HCC 48 in the model, ICD-10-CM guidelines require an associated provider-documented obesity diagnosis to code it.
- •Z68.45 (BMI >= 70) maps to V28 HCC 48 (Morbid Obesity) at RAF 0.186 in the model; pair it with the provider's obesity diagnosis (E66.01/E66.2/E66.813) to code it compliantly.
Clinical Significance
This code indicates the most severe level of obesity with BMI 70 or greater, representing extreme health risk requiring immediate intensive medical management and urgent surgical intervention. Super-morbid obesity at this level is associated with dramatically increased mortality and requires specialized tertiary care management.
Documentation Requirements
- ✓Documented BMI calculation of 70 or greater
- ✓Patient age confirmed as adult (18+ years)
- ✓Height and weight measurements supporting BMI calculation
- ✓Comprehensive assessment of obesity-related complications
- ✓Provider documentation of super-morbid obesity
- ✓Multiple serious comorbidities typically documented
- ✓Urgent multidisciplinary treatment plan including immediate surgical evaluation
- ✓Specialized bariatric center referrals