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

ICD-10 E23.6

Billable / Specific HCC v28: 23

Other disorders of pituitary gland

E23
Block
2
Synonyms
146
LCDs
10
Payer Policies
7
Linked CPTs

About ICD-10-CM E23.6

ICD-10-CM code E23.6 represents Other disorders of pituitary gland. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E23). The 2026 edition of ICD-10-CM E23.6 became effective on October 1, 2025.

Coding Tips for E23.6

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

HCC capture: document with MEAT each year

E23.6 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 E23.6. Per CMS ICD-10-CM Tabular 2026.

  • Abscess of pituitary
  • Adiposogenital dystrophy

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 E23.6

Local Coverage Determinations (LCDs) from CMS MACs that list E23.6 as a covered diagnosis.

146 LCDs

Showing top 10 of 146 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Visual Fields Testing
Article ID: 56551, Effective: 2025-10-01 00:00:00, 1427 covered, 0 non-covered
CPT 92082 →
CMS LCD: Billing and Coding: Visual Fields Testing
Article ID: 56551, Effective: 2025-10-01 00:00:00, 1427 covered, 0 non-covered
CPT 92083 →
CMS LCD: Billing and Coding: Visual Fields Testing
Article ID: 56551, Effective: 2025-10-01 00:00:00, 1427 covered, 0 non-covered
CPT 92081 →
CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone
Article ID: 58828, Effective: 2026-04-02 00:00:00, 39 covered, 0 non-covered
CPT J1071 →
CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone
Article ID: 58828, Effective: 2026-04-02 00:00:00, 39 covered, 0 non-covered
CPT J3145 →
CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone
Article ID: 58828, Effective: 2026-04-02 00:00:00, 39 covered, 0 non-covered
CPT 84410 →
CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone
Article ID: 58828, Effective: 2026-04-02 00:00:00, 39 covered, 0 non-covered
CPT 84403 →
CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone
Article ID: 58828, Effective: 2026-04-02 00:00:00, 39 covered, 0 non-covered
CPT 11980 →
CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone
Article ID: 58828, Effective: 2026-04-02 00:00:00, 39 covered, 0 non-covered
CPT J3121 →
CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone
Article ID: 58828, Effective: 2026-04-02 00:00:00, 39 covered, 0 non-covered
CPT 96372 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing E23.6.

10 policies

5 Medicare

Billing and Coding: Visual Fields Testing
Policy ID: ART-56551
Billing and Coding: CT of the Head
Policy ID: ART-56612
Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography
Policy ID: ART-56631
Billing and Coding: Visual Fields Testing
Policy ID: ART-56799
Billing and Coding: Aortography and Peripheral Angiography
Policy ID: ART-57056

1 Aetna

Infertility
Policy ID: CPB-0327

CPT Codes Commonly Billed with E23.6

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

7 linkages
  • J3145 CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone CMS LCD
  • 84403 CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone CMS LCD
  • 84410 CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone CMS LCD
  • J1072 CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone CMS LCD
  • 11980 CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone CMS LCD
  • J1071 CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone CMS LCD
  • J3121 CMS LCD: Billing and Coding: Treatment of Males with Low Testosterone CMS LCD

Convert E23.6 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
E23.6 2538 10000

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

ICD-10 E23.6, Billing FAQ

Is ICD-10 code E23.6 billable? +

Yes, E23.6 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 E23.6? +

ICD-10 E23.6 includes: Abscess of pituitary; Adiposogenital dystrophy.

Does E23.6 affect Medicare Advantage HCC risk adjustment? +

Yes. E23.6 maps to CMS-HCC v28 category 23. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What CPT codes are commonly billed with E23.6? +

Procedures frequently paired with E23.6 include: J3145, 84403, 84410, J1072, 11980.

What ICD-9 codes does E23.6 map to? +

Per CMS GEMs, E23.6 maps to ICD-9 codes: 2538. 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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