Z89.231
BillableAcquired absence of right shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z89.231 an HCC code?
No. Z89.231 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
Z89.231 is the ICD-10-CM diagnosis code for acquired absence of right shoulder. A person who has lost their right shoulder and arm due to amputation or other acquired cause. Z89.231 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons with potential health hazards related to family and personal history and certain conditions influencing health status (z77-z99).
Z89.231 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.
Disarticulation at the shoulder is more extensive than above-elbow amputation; ensure the documentation specifies shoulder-level loss.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z89.231 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Disarticulation at the shoulder is more extensive than above-elbow amputation; ensure the documentation specifies shoulder-level loss
- •Verify this is an acquired condition and not congenital absence of the shoulder