Z96.41 ICD-10-CM Code: Presence of insulin pump (external) (internal)
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FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)
Z96.41
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePresence of insulin pump (external) (internal)
A patient has an insulin pump implanted in their body or is using an external insulin pump to automatically deliver insulin for diabetes management.
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
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for Z96.41 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Z96.41 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Z96.41 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for Z96.41 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Z96.41 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Z96.41 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Z96.41 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 Z96.41 an HCC code?
No. Z96.41 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
Z96.41 is the ICD-10-CM diagnosis code for presence of insulin pump (external) (internal). A patient has an insulin pump implanted in their body or is using an external insulin pump to automatically deliver insulin for diabetes management. Z96.41 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).
Z96.41 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.
Clarify whether the pump is internal (implanted) or external in the documentation, as this affects clinical management and patient education.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z96.41 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.