Z68.45
BillableBody mass index [BMI] 70 or greater, adult
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z68.45 an HCC code?
Yes. Z68.45 maps to Morbid Obesity under the CMS-HCC V28 risk adjustment model (and Morbid Obesity 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 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.
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 0.226. 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 codes are status codes used for documentation purposes and should be reported alongside the diagnosis of obesity (E66.x) when applicable. 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 codes are status codes used for documentation purposes and should be reported alongside the diagnosis of obesity (E66.x) when applicable
- •Ensure the BMI calculation is documented in the medical record; these codes require actual BMI values, not estimates
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