ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 E21.0

Billable / Specific HCC v28: 23

Primary hyperparathyroidism

E21
Block
2
Synonyms
102
LCDs
16
Payer Policies
14
Linked CPTs

About ICD-10-CM E21.0

ICD-10-CM code E21.0 represents Primary hyperparathyroidism. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E21). The 2026 edition of ICD-10-CM E21.0 became effective on October 1, 2025.

Coding Tips for E21.0

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

HCC capture: document with MEAT each year

E21.0 is a CMS-HCC v28 risk-adjustment code (category 23). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under E21.0. Per CMS ICD-10-CM Tabular 2026.

  • Hyperplasia of parathyroid
  • Osteitis fibrosa cystica generalisata [von Recklinghausen's disease of bone]

Medicare Advantage HCC Impact

CMS-HCC v28 (current)
Category 23
ESRD-HCC
Category 23
RxHCC (Part D)
Category 23

Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.

Medicare LCD Coverage for E21.0

Local Coverage Determinations (LCDs) from CMS MACs that list E21.0 as a covered diagnosis.

102 LCDs

Showing top 10 of 102 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Magnesium
Article ID: 59186, Effective: 2025-10-01 00:00:00, 4358 covered, 0 non-covered
CPT 83735 →
CMS LCD: Billing and Coding: Vitamin D Assay Testing
Article ID: 57736, Effective: 2024-10-01 00:00:00, 553 covered, 0 non-covered
CPT 82652 →
CMS LCD: Billing and Coding: Vitamin D Assay Testing
Article ID: 57736, Effective: 2024-10-01 00:00:00, 553 covered, 0 non-covered
CPT 82306 →
CMS LCD: Billing and Coding: Vitamin D; 25 hydroxy, includes fraction(s), if performed
Article ID: 56841, Effective: 2023-10-01 00:00:00, 759 covered, 1 non-covered
CPT 82306 →
CMS LCD: Billing and Coding: Assays for Vitamins and Metabolic Function
Article ID: 56416, Effective: 2025-10-01 00:00:00, 899 covered, 1 non-covered
CPT 82306 →
CMS LCD: Billing and Coding: Assays for Vitamins and Metabolic Function
Article ID: 56416, Effective: 2025-10-01 00:00:00, 899 covered, 1 non-covered
CPT 82607 →
CMS LCD: Billing and Coding: Assays for Vitamins and Metabolic Function
Article ID: 56416, Effective: 2025-10-01 00:00:00, 899 covered, 1 non-covered
CPT 82746 →
CMS LCD: Billing and Coding: Assays for Vitamins and Metabolic Function
Article ID: 56416, Effective: 2025-10-01 00:00:00, 899 covered, 1 non-covered
CPT 85385 →
CMS LCD: Billing and Coding: Assays for Vitamins and Metabolic Function
Article ID: 56416, Effective: 2025-10-01 00:00:00, 899 covered, 1 non-covered
CPT 83090 →
CMS LCD: Billing and Coding: Assays for Vitamins and Metabolic Function
Article ID: 56416, Effective: 2025-10-01 00:00:00, 899 covered, 1 non-covered
CPT 82652 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing E21.0.

16 policies

2 Cigna

Head and Neck Ultrasound - (0549)
Policy ID: MM_0549
Vitamin D Testing - (0526) ---- future effective policy
Policy ID: MM_0526

5 Medicare

Billing and Coding: Assays for Vitamins and Metabolic Function
Policy ID: ART-56416
Billing and Coding: Vitamin D Assay Testing
Policy ID: ART-56798
Billing and Coding: Vitamin D; 25 hydroxy, includes fraction(s), if performed
Policy ID: ART-56841
Billing and Coding: Parathormone (Parathyroid Hormone)
Policy ID: ART-57122
Billing and Coding: Bone Mass Measurement
Policy ID: ART-57132

CPT Codes Commonly Billed with E21.0

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

14 linkages
  • 77081 CMS LCD: Billing and Coding: Bone Mass Measurement CMS LCD
  • 0556T CMS LCD: Billing and Coding: Bone Mass Measurement CMS LCD
  • 78350 CMS LCD: Billing and Coding: Bone Mass Measurement CMS LCD
  • 0554T CMS LCD: Billing and Coding: Bone Mass Measurement CMS LCD
  • 77085 CMS LCD: Billing and Coding: Bone Mass Measurement CMS LCD
  • 0558T CMS LCD: Billing and Coding: Bone Mass Measurement CMS LCD
  • 0555T CMS LCD: Billing and Coding: Bone Mass Measurement CMS LCD
  • 0557T CMS LCD: Billing and Coding: Bone Mass Measurement CMS LCD
  • 77078 CMS LCD: Billing and Coding: Bone Mass Measurement CMS LCD
  • 76977 CMS LCD: Billing and Coding: Bone Mass Measurement CMS LCD

Convert E21.0 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
E21.0 25201 00000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 E21.0, Billing FAQ

Is ICD-10 code E21.0 billable? +

Yes, E21.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to E21.0? +

ICD-10 E21.0 includes: Hyperplasia of parathyroid; Osteitis fibrosa cystica generalisata [von Recklinghausen's disease of bone].

Does E21.0 affect Medicare Advantage HCC risk adjustment? +

Yes. E21.0 maps to CMS-HCC v28 category 23. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What CPT codes are commonly billed with E21.0? +

Procedures frequently paired with E21.0 include: 77081, 0556T, 78350, 0554T, 77085.

What ICD-9 codes does E21.0 map to? +

Per CMS GEMs, E21.0 maps to ICD-9 codes: 25201. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

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