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

ICD-10 E66.813

Billable / Specific HCC v28: 22

Obesity, class 3

E66
Block
0
Synonyms
143
LCDs
12
Payer Policies
5
Linked CPTs

About ICD-10-CM E66.813

ICD-10-CM code E66.813 represents Obesity, class 3. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E66). The 2026 edition of ICD-10-CM E66.813 became effective on October 1, 2025.

Coding Tips for E66.813

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

HCC capture: document with MEAT each year

E66.813 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.

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 E66.813

Local Coverage Determinations (LCDs) from CMS MACs that list E66.813 as a covered diagnosis.

143 LCDs

Showing top 10 of 143 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 E66.813.

12 policies

5 Medicare

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: Surgical Management of Morbid Obesity
Policy ID: ART-57145
Billing and Coding: Transesophageal Echocardiogram
Policy ID: ART-57179

1 Aetna

Brain Natriuretic Peptide Testing
Policy ID: CPB-0618

CPT Codes Commonly Billed with E66.813

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

5 linkages
  • 0003M CMS LCD: Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis CMS LCD
  • 0468U CMS LCD: Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis CMS LCD
  • 0166U CMS LCD: Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis CMS LCD
  • 81517 CMS LCD: Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis CMS LCD
  • 0344U CMS LCD: Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis CMS LCD

ICD-10 E66.813, Billing FAQ

Is ICD-10 code E66.813 billable? +

Yes, E66.813 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

Does E66.813 affect Medicare Advantage HCC risk adjustment? +

Yes. E66.813 maps to CMS-HCC v28 category 22. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What CPT codes are commonly billed with E66.813? +

Procedures frequently paired with E66.813 include: 0003M, 0468U, 0166U, 81517, 0344U.

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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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