Question 1

What is ICD-10 code Z91.A91?

Accepted Answer

Z91.A91 is the ICD-10-CM diagnosis code for Caregiver's noncompliance with patient's other medical treatment and regimen due to financial hardship. A caregiver is unable or unwilling to follow the patient's medical treatment plan because of financial difficulties. Z91.A91 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. Z91.A91 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Question 2

Is Z91.A91 an HCC code?

Accepted Answer

No. Z91.A91 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 Z91.A91 billable?

Accepted Answer

Yes. Z91.A91 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. Z91.A91 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 Z91.A91?

Accepted Answer

Z91.A91 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 Z91.A91 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 Z91.A91?

Accepted Answer

Document the specific financial barrier when possible to support medical necessity for assistance programs or social work referrals This code captures an important social determinant of health that may affect treatment outcomes and should prompt intervention

Z91.A91

Is Z91.A91 an HCC code?

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