ICD-10 G40.A01
Billable / Specific HCC v28: 79Absence epileptic syndrome, not intractable, with status epilepticus
About ICD-10-CM G40.A01
ICD-10-CM code G40.A01 represents Absence epileptic syndrome, not intractable, with status epilepticus. This is a billable/specific code in the Nervous System chapter (block G40). The 2026 edition of ICD-10-CM G40.A01 became effective on October 1, 2025.
Coding Tips for G40.A01
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G40.A01 is a CMS-HCC v28 risk-adjustment code (category 79). 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
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 G40.A01
Local Coverage Determinations (LCDs) from CMS MACs that list G40.A01 as a covered diagnosis.
Showing top 10 of 334 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G40.A01.
5 Medicare
CPT Codes Commonly Billed with G40.A01
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 95711 CMS LCD: Billing and Coding: EEG � Ambulatory Monitoring CMS LCD
- 95714 CMS LCD: Billing and Coding: EEG � Ambulatory Monitoring CMS LCD
- 95726 CMS LCD: Billing and Coding: EEG � Ambulatory Monitoring CMS LCD
- 95709 CMS LCD: Billing and Coding: EEG � Ambulatory Monitoring CMS LCD
- 95723 CMS LCD: Billing and Coding: EEG � Ambulatory Monitoring CMS LCD
- 95710 CMS LCD: Billing and Coding: EEG � Ambulatory Monitoring CMS LCD
- 95716 CMS LCD: Billing and Coding: EEG � Ambulatory Monitoring CMS LCD
- 95707 CMS LCD: Billing and Coding: EEG � Ambulatory Monitoring CMS LCD
- 95712 CMS LCD: Billing and Coding: EEG � Ambulatory Monitoring CMS LCD
- 95724 CMS LCD: Billing and Coding: EEG � Ambulatory Monitoring CMS LCD
Convert G40.A01 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| G40.A01 | 34500 | 10000 |
| G40.A01 | 3452 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To G40.A01
Other codes in section G40-G47 (Episodic and paroxysmal disorders).
ICD-10 G40.A01, Billing FAQ
Is ICD-10 code G40.A01 billable? +
Yes, G40.A01 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does G40.A01 affect Medicare Advantage HCC risk adjustment? +
Yes. G40.A01 maps to CMS-HCC v28 category 79. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with G40.A01? +
Procedures frequently paired with G40.A01 include: 95711, 95714, 95726, 95709, 95723.
What ICD-9 codes does G40.A01 map to? +
Per CMS GEMs, G40.A01 maps to ICD-9 codes: 34500, 3452. 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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