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

ICD-10 E75.241

Billable / Specific HCC v28: 23

Niemann-Pick disease type B

E75
Block
2
Synonyms
86
LCDs
10
Payer Policies
10
Linked CPTs

About ICD-10-CM E75.241

ICD-10-CM code E75.241 represents Niemann-Pick disease type B. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E75). The 2026 edition of ICD-10-CM E75.241 became effective on October 1, 2025.

Coding Tips for E75.241

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

HCC capture: document with MEAT each year

E75.241 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 E75.241. Per CMS ICD-10-CM Tabular 2026.

  • Acid sphingomyelinase deficiency type B (ASMD type B)
  • Chronic visceral acid sphingomyelinase deficiency

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 E75.241

Local Coverage Determinations (LCDs) from CMS MACs that list E75.241 as a covered diagnosis.

86 LCDs

Showing top 10 of 86 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Routine Foot Care
Article ID: 57188, Effective: 2025-10-01 00:00:00, 812 covered, 1 non-covered
CPT 11719 →
CMS LCD: Billing and Coding: Routine Foot Care
Article ID: 57188, Effective: 2025-10-01 00:00:00, 812 covered, 1 non-covered
CPT 11721 →
CMS LCD: Billing and Coding: Routine Foot Care
Article ID: 57188, Effective: 2025-10-01 00:00:00, 812 covered, 1 non-covered
CPT 11057 →
CMS LCD: Billing and Coding: Routine Foot Care
Article ID: 57188, Effective: 2025-10-01 00:00:00, 812 covered, 1 non-covered
CPT 11720 →
CMS LCD: Billing and Coding: Routine Foot Care
Article ID: 57188, Effective: 2025-10-01 00:00:00, 812 covered, 1 non-covered
CPT G0127 →
CMS LCD: Billing and Coding: Routine Foot Care
Article ID: 57188, Effective: 2025-10-01 00:00:00, 812 covered, 1 non-covered
CPT 11055 →
CMS LCD: Billing and Coding: Routine Foot Care
Article ID: 57188, Effective: 2025-10-01 00:00:00, 812 covered, 1 non-covered
CPT 11056 →
CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
Article ID: 57559, Effective: 2025-10-01 00:00:00, 179 covered, 0 non-covered
CPT 86141 →
CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
Article ID: 57559, Effective: 2025-10-01 00:00:00, 179 covered, 0 non-covered
CPT 83090 →
CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
Article ID: 57559, Effective: 2025-10-01 00:00:00, 179 covered, 0 non-covered
CPT 83704 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing E75.241.

10 policies

5 Medicare

Billing and Coding: Routine Foot Care
Policy ID: ART-52996
Billing and Coding: Foot Care
Policy ID: ART-56232
Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
Policy ID: ART-56943
Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
Policy ID: ART-57037
Billing and Coding: Routine Foot Care
Policy ID: ART-57188

CPT Codes Commonly Billed with E75.241

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

10 linkages
  • 83090 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
  • 83700 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
  • 82172 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
  • 86141 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
  • 83701 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
  • 83719 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
  • 83721 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
  • 83698 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
  • 83695 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD
  • 83704 CMS LCD: Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment CMS LCD

Convert E75.241 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
E75.241 2727 10000

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

ICD-10 E75.241, Billing FAQ

Is ICD-10 code E75.241 billable? +

Yes, E75.241 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 E75.241? +

ICD-10 E75.241 includes: Acid sphingomyelinase deficiency type B (ASMD type B); Chronic visceral acid sphingomyelinase deficiency.

Does E75.241 affect Medicare Advantage HCC risk adjustment? +

Yes. E75.241 maps to CMS-HCC v28 category 23. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What CPT codes are commonly billed with E75.241? +

Procedures frequently paired with E75.241 include: 83090, 83700, 82172, 86141, 83701.

What ICD-9 codes does E75.241 map to? +

Per CMS GEMs, E75.241 maps to ICD-9 codes: 2727. 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 July 16, 2026.

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