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

ICD-10 E66.01

Billable / Specific HCC v28: 22

Morbid (severe) obesity due to excess calories

E66
Block
0
Synonyms
180
LCDs
19
Payer Policies
19
Linked CPTs

About ICD-10-CM E66.01

ICD-10-CM code E66.01 represents Morbid (severe) obesity due to excess calories. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E66). The 2026 edition of ICD-10-CM E66.01 became effective on October 1, 2025.

Coding Tips for E66.01

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

HCC capture: document with MEAT each year

E66.01 is a CMS-HCC v28 risk-adjustment code (category 22). 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.

Type 1 Excludes

Pure excludes, these codes can never be coded together with E66.01. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • morbid (severe) obesity with alveolar hypoventilation (E66.2)

Medicare Advantage HCC Impact

CMS-HCC v28 (current)
Category 22
ESRD-HCC
Category 22
RxHCC (Part D)
Category 22

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 E66.01

Local Coverage Determinations (LCDs) from CMS MACs that list E66.01 as a covered diagnosis.

180 LCDs

Showing top 10 of 180 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Transesophageal Echocardiogram
Article ID: 57179, Effective: 2026-02-26 00:00:00, 421 covered, 1 non-covered
CPT 93313 →
CMS LCD: Billing and Coding: Transesophageal Echocardiogram
Article ID: 57179, Effective: 2026-02-26 00:00:00, 421 covered, 1 non-covered
CPT 93312 →
CMS LCD: Billing and Coding: Transesophageal Echocardiogram
Article ID: 57179, Effective: 2026-02-26 00:00:00, 421 covered, 1 non-covered
CPT 93318 →
CMS LCD: Billing and Coding: Transesophageal Echocardiogram
Article ID: 57179, Effective: 2026-02-26 00:00:00, 421 covered, 1 non-covered
CPT 93317 →
CMS LCD: Billing and Coding: Transesophageal Echocardiogram
Article ID: 57179, Effective: 2026-02-26 00:00:00, 421 covered, 1 non-covered
CPT C8927 →
CMS LCD: Billing and Coding: Transesophageal Echocardiogram
Article ID: 57179, Effective: 2026-02-26 00:00:00, 421 covered, 1 non-covered
CPT C8925 →
CMS LCD: Billing and Coding: Transesophageal Echocardiogram
Article ID: 57179, Effective: 2026-02-26 00:00:00, 421 covered, 1 non-covered
CPT 93314 →
CMS LCD: Billing and Coding: Transesophageal Echocardiogram
Article ID: 57179, Effective: 2026-02-26 00:00:00, 421 covered, 1 non-covered
CPT C8926 →
CMS LCD: Billing and Coding: Transesophageal Echocardiogram
Article ID: 57179, Effective: 2026-02-26 00:00:00, 421 covered, 1 non-covered
CPT 93316 →
CMS LCD: Billing and Coding: Transesophageal Echocardiogram
Article ID: 57179, Effective: 2026-02-26 00:00:00, 421 covered, 1 non-covered
CPT 93315 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing E66.01.

19 policies

5 Aetna

Weight Reduction Programs and Devices - Medical Clinical Policy Bulletins | Aetna
Policy ID: CPB-0039
Nutritional Counseling - Medical Clinical Policy Bulletins | Aetna
Policy ID: CPB-0049
Obesity Surgery
Policy ID: CPB-0157
Helicobacter Pylori Infection Testing
Policy ID: CPB-0177
Pancreas Kidney Transplantation
Policy ID: CPB-0587

3 Cigna

Anesthesia Services for Interventional Pain Management Procedures in an Adult - (0551)
Policy ID: MM_0551
Plasma Brain Natriuretic Peptide in the Outpatient Setting - (0028)
Policy ID: MM_0028
Vitamin D Testing - (0526) ---- future effective policy
Policy ID: MM_0526

5 Medicare

Laparoscopic Sleeve Gastrectomy (LSG) � Medical Policy Article
Policy ID: ART-52447
Billing and Coding: Bariatric Surgery for Treatment of Co-Morbidities Conditions Related to Morbid Obesity
Policy ID: ART-54923
Billing and Coding: Laparoscopic Sleeve Gastrectomy for Severe Obesity
Policy ID: ART-56852
Billing and Coding: Outpatient Psychiatry and Psychology Services
Policy ID: ART-57065
Billing and Coding: Psychiatric Codes
Policy ID: ART-57130

CPT Codes Commonly Billed with E66.01

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

19 linkages
  • 99204 New patient office visit — multiple chronic conditions: HTN, T2DM, hyperlipidemia, asthma, anxiety, depression, obesity, IBS, COPD, thyroid, anemia, CAD, sleep apnea, psoriasis, RA Primary Care
  • 99205 New patient office visit — complex/high-risk: uncontrolled diabetes, heart failure, COPD exacerbation, cancer, MS, RA, CKD, CAD, recurrent depression, epilepsy, lupus, syncope, cognitive decline Primary Care
  • 99213 Established patient — HTN follow-up, diabetes management, hyperlipidemia, asthma, anxiety, common complaints, back pain, GERD, migraine, acne, joint pain, prediabetes, obesity, anemia, hypothyroid, fatigue Primary Care
  • 99214 Established patient — moderate complexity: uncontrolled HTN, diabetes with complications, multiple chronic conditions, COPD, AFib, CKD, sleep apnea, chronic pain, depression Primary Care
  • 99215 Established patient — high complexity: HF exacerbation, COPD exacerbation, cancer management, MS, advanced CKD, uncontrolled diabetes, recurrent syncope, respiratory failure, liver cirrhosis Primary Care
  • 80061 Lipid panel — hyperlipidemia, hypercholesterolemia, hypertriglyceridemia, CAD, HTN, diabetes, lipid screening, family hx heart disease, obesity Laboratory
  • 90865 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
  • 90889 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
  • G0451 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
  • 90880 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD

Convert E66.01 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
E66.01 27801 10000

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

ICD-10 E66.01, Billing FAQ

Is ICD-10 code E66.01 billable? +

Yes, E66.01 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What codes are Type 1 Excludes for E66.01? +

Type 1 Excludes (never code together with E66.01): morbid (severe) obesity with alveolar hypoventilation (E66.2)

Does E66.01 affect Medicare Advantage HCC risk adjustment? +

Yes. E66.01 maps to CMS-HCC v28 category 22. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What CPT codes are commonly billed with E66.01? +

Procedures frequently paired with E66.01 include: 99204, 99205, 99213, 99214, 99215.

What ICD-9 codes does E66.01 map to? +

Per CMS GEMs, E66.01 maps to ICD-9 codes: 27801. 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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