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

ICD-10 E31.21

Billable / Specific HCC v28: 23

Multiple endocrine neoplasia [MEN] type I

E31
Block
1
Synonyms
281
LCDs
4
Payer Policies
0
Linked CPTs

About ICD-10-CM E31.21

ICD-10-CM code E31.21 represents Multiple endocrine neoplasia [MEN] type I. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E31). The 2026 edition of ICD-10-CM E31.21 became effective on October 1, 2025.

Coding Tips for E31.21

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

HCC capture: document with MEAT each year

E31.21 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 E31.21. Per CMS ICD-10-CM Tabular 2026.

  • Wermer's syndrome

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 E31.21

Local Coverage Determinations (LCDs) from CMS MACs that list E31.21 as a covered diagnosis.

281 LCDs

Showing top 10 of 281 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: CT of the Head
Article ID: 56612, Effective: 2025-10-01 00:00:00, 7586 covered, 0 non-covered
CPT G2187 →
CMS LCD: Billing and Coding: CT of the Head
Article ID: 56612, Effective: 2025-10-01 00:00:00, 7586 covered, 0 non-covered
CPT G2188 →
CMS LCD: Billing and Coding: CT of the Head
Article ID: 56612, Effective: 2025-10-01 00:00:00, 7586 covered, 0 non-covered
CPT G2195 →
CMS LCD: Billing and Coding: CT of the Head
Article ID: 56612, Effective: 2025-10-01 00:00:00, 7586 covered, 0 non-covered
CPT G2189 →
CMS LCD: Billing and Coding: CT of the Head
Article ID: 56612, Effective: 2025-10-01 00:00:00, 7586 covered, 0 non-covered
CPT G2194 →
CMS LCD: Billing and Coding: CT of the Head
Article ID: 56612, Effective: 2025-10-01 00:00:00, 7586 covered, 0 non-covered
CPT G2193 →
CMS LCD: Billing and Coding: CT of the Head
Article ID: 56612, Effective: 2025-10-01 00:00:00, 7586 covered, 0 non-covered
CPT G2192 →
CMS LCD: Billing and Coding: CT of the Head
Article ID: 56612, Effective: 2025-10-01 00:00:00, 7586 covered, 0 non-covered
CPT G2190 →
CMS LCD: Billing and Coding: CT of the Head
Article ID: 56612, Effective: 2025-10-01 00:00:00, 7586 covered, 0 non-covered
CPT 70460 →
CMS LCD: Billing and Coding: CT of the Head
Article ID: 56612, Effective: 2025-10-01 00:00:00, 7586 covered, 0 non-covered
CPT G2191 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing E31.21.

4 policies

3 Medicare

Billing and Coding: CT of the Head
Policy ID: ART-56612
Billing and Coding: MRI and CT Scans of the Head and Neck
Policy ID: ART-57204
Billing and Coding: Genetic Testing for Oncology
Policy ID: ART-59491

1 Aetna

Genetic Testing
Policy ID: CPB-0140

CPT Codes Commonly Billed with E31.21

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

No procedure linkages on file for E31.21

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert E31.21 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
E31.21 25801 00000

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

ICD-10 E31.21, Billing FAQ

Is ICD-10 code E31.21 billable? +

Yes, E31.21 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 E31.21? +

ICD-10 E31.21 includes: Wermer's syndrome.

Does E31.21 affect Medicare Advantage HCC risk adjustment? +

Yes. E31.21 maps to CMS-HCC v28 category 23. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What ICD-9 codes does E31.21 map to? +

Per CMS GEMs, E31.21 maps to ICD-9 codes: 25801. 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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