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

ICD-10 G21.0

Billable / Specific MCC

Malignant neuroleptic syndrome

G21
Block
0
Synonyms
292
LCDs
16
Payer Policies
21
Linked CPTs

About ICD-10-CM G21.0

ICD-10-CM code G21.0 represents Malignant neuroleptic syndrome. This is a billable/specific code in the Nervous System chapter (block G21). The 2026 edition of ICD-10-CM G21.0 became effective on October 1, 2025.

Coding Tips for G21.0

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

Inpatient DRG impact: MCC

G21.0 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.

Type 1 Excludes

Pure excludes, these codes can never be coded together with G21.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • neuroleptic induced parkinsonism (G21.11)

Use Additional Code

When coding G21.0, also report these additional codes when applicable.

  • code for adverse effect, if applicable, to identify drug (T43.3X5, T43.4X5, T43.505, T43.595)

Inpatient DRG Impact, MCC

codes Malignant neuroleptic syndrome. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.

Medicare LCD Coverage for G21.0

Local Coverage Determinations (LCDs) from CMS MACs that list G21.0 as a covered diagnosis.

292 LCDs

Showing top 10 of 292 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92524 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 96112 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92521 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97130 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97129 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92597 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97110 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97533 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 96110 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92522 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing G21.0.

16 policies

4 Aetna

Stereotactic Radiosurgery - Medical Clinical Policy Bulletins | Aetna
Policy ID: CPB-0083
Thalamotomy
Policy ID: CPB-0153
Deep Brain Stimulation
Policy ID: CPB-0208
Parkinson's Disease
Policy ID: CPB-0307

5 Medicare

Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Policy ID: ART-54111
Billing and Coding: CT of the Head
Policy ID: ART-56612
Billing and Coding: Nerve Conduction Studies and Electromyography
Policy ID: ART-56619
Billing and Coding: Home Health - Psychiatric Care
Policy ID: ART-56756
Billing and Coding: Neurophysiology Evoked Potentials (NEPs)
Policy ID: ART-56773

CPT Codes Commonly Billed with G21.0

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

21 linkages
  • 92571 CMS LCD: Billing and Coding: Vestibular and Audiologic Function Studies CMS LCD
  • 92568 CMS LCD: Billing and Coding: Vestibular and Audiologic Function Studies CMS LCD
  • 92620 CMS LCD: Billing and Coding: Vestibular and Audiologic Function Studies CMS LCD
  • 92588 CMS LCD: Billing and Coding: Vestibular and Audiologic Function Studies CMS LCD
  • 92572 CMS LCD: Billing and Coding: Vestibular and Audiologic Function Studies CMS LCD
  • 92579 CMS LCD: Billing and Coding: Vestibular and Audiologic Function Studies CMS LCD
  • 92582 CMS LCD: Billing and Coding: Vestibular and Audiologic Function Studies CMS LCD
  • 92576 CMS LCD: Billing and Coding: Vestibular and Audiologic Function Studies CMS LCD
  • 92621 CMS LCD: Billing and Coding: Vestibular and Audiologic Function Studies CMS LCD
  • 92570 CMS LCD: Billing and Coding: Vestibular and Audiologic Function Studies CMS LCD

Convert G21.0 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
G21.0 33392 00000

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

ICD-10 G21.0, Billing FAQ

Is ICD-10 code G21.0 billable? +

Yes, G21.0 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 G21.0? +

Type 1 Excludes (never code together with G21.0): neuroleptic induced parkinsonism (G21.11)

Is G21.0 a CC or MCC for inpatient DRG? +

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

What CPT codes are commonly billed with G21.0? +

Procedures frequently paired with G21.0 include: 92571, 92568, 92620, 92588, 92572.

What ICD-9 codes does G21.0 map to? +

Per CMS GEMs, G21.0 maps to ICD-9 codes: 33392. 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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