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

ICD-10 E55.0

Billable / Specific CC

Rickets, active

E55
Block
2
Synonyms
20
LCDs
8
Payer Policies
0
Linked CPTs

About ICD-10-CM E55.0

ICD-10-CM code E55.0 represents Rickets, active. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E55). The 2026 edition of ICD-10-CM E55.0 became effective on October 1, 2025.

Coding Tips for E55.0

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

Inpatient DRG impact: CC

E55.0 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under E55.0. Per CMS ICD-10-CM Tabular 2026.

  • Infantile osteomalacia
  • Juvenile osteomalacia

Type 1 Excludes

Pure excludes, these codes can never be coded together with E55.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • celiac rickets (K90.0)
  • Crohn's rickets (K50.-)
  • hereditary vitamin D-dependent rickets (E83.32)
  • inactive rickets (E64.3)
  • renal rickets (N25.0)
  • sequelae of rickets (E64.3)
  • vitamin D-resistant rickets (E83.31)

Inpatient DRG Impact, CC

codes Rickets, active. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.

Medicare LCD Coverage for E55.0

Local Coverage Determinations (LCDs) from CMS MACs that list E55.0 as a covered diagnosis.

20 LCDs

Showing top 10 of 20 total . Click a CPT for full coverage scope.

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 →
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 84207 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing E55.0.

8 policies

1 Cigna

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: Vitamin D Assay Testing
Policy ID: ART-57484
Billing and Coding: Vitamin D Assay Testing
Policy ID: ART-57718

CPT Codes Commonly Billed with E55.0

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

No procedure linkages on file for E55.0

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 E55.0 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
E55.0 2680 00000

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

ICD-10 E55.0, Billing FAQ

Is ICD-10 code E55.0 billable? +

Yes, E55.0 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 E55.0? +

ICD-10 E55.0 includes: Infantile osteomalacia; Juvenile osteomalacia.

What codes are Type 1 Excludes for E55.0? +

Type 1 Excludes (never code together with E55.0): celiac rickets (K90.0); Crohn's rickets (K50.-); hereditary vitamin D-dependent rickets (E83.32)

Is E55.0 a CC or MCC for inpatient DRG? +

Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.

What ICD-9 codes does E55.0 map to? +

Per CMS GEMs, E55.0 maps to ICD-9 codes: 2680. 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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