ICD-10 G12.25
Billable / Specific HCC v28: 73 CCProgressive spinal muscle atrophy
About ICD-10-CM G12.25
ICD-10-CM code G12.25 represents Progressive spinal muscle atrophy. This is a billable/specific code in the Nervous System chapter (block G12). The 2026 edition of ICD-10-CM G12.25 became effective on October 1, 2025.
Coding Tips for G12.25
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G12.25 is a CMS-HCC v28 risk-adjustment code (category 73). 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.
G12.25 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.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Progressive spinal muscle atrophy. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for G12.25
Local Coverage Determinations (LCDs) from CMS MACs that list G12.25 as a covered diagnosis.
Showing top 10 of 651 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G12.25.
3 Cigna
5 Medicare
CPT Codes Commonly Billed with G12.25
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 95926 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 95925 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 95938 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 95927 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 29405 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 95992 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 29280 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 97010 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 29515 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 97550 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
Codes Adjacent To G12.25
Other codes in section G10-G14 (Systemic atrophies primarily affecting the central nervous system).
ICD-10 G12.25, Billing FAQ
Is ICD-10 code G12.25 billable? +
Yes, G12.25 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does G12.25 affect Medicare Advantage HCC risk adjustment? +
Yes. G12.25 maps to CMS-HCC v28 category 73. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is G12.25 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 CPT codes are commonly billed with G12.25? +
Procedures frequently paired with G12.25 include: 95926, 95925, 95938, 95927, 29405.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team