ICD-10 G54.7
Billable / Specific HCC v28: 189Phantom limb syndrome without pain
About ICD-10-CM G54.7
ICD-10-CM code G54.7 represents Phantom limb syndrome without pain. This is a billable/specific code in the Nervous System chapter (block G54). The 2026 edition of ICD-10-CM G54.7 became effective on October 1, 2025.
Coding Tips for G54.7
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G54.7 is a CMS-HCC v28 risk-adjustment code (category 189). 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 G54.7. Per CMS ICD-10-CM Tabular 2026.
- Phantom limb syndrome NOS
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 G54.7
Local Coverage Determinations (LCDs) from CMS MACs that list G54.7 as a covered diagnosis.
Showing top 10 of 558 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G54.7.
1 Cigna
5 Medicare
1 Aetna
CPT Codes Commonly Billed with G54.7
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- G0151 CMS LCD: Billing and Coding: Home Health Physical Therapy CMS LCD
- G0159 CMS LCD: Billing and Coding: Home Health Physical Therapy CMS LCD
- G2168 CMS LCD: Billing and Coding: Home Health Physical Therapy CMS LCD
- G0157 CMS LCD: Billing and Coding: Home Health Physical Therapy CMS LCD
- 98977 CMS LCD: Billing and Coding: Physical Therapy - Home Health CMS LCD
- G2251 CMS LCD: Billing and Coding: Physical Therapy - Home Health CMS LCD
- 98970 CMS LCD: Billing and Coding: Physical Therapy - Home Health CMS LCD
- 98976 CMS LCD: Billing and Coding: Physical Therapy - Home Health CMS LCD
- 98981 CMS LCD: Billing and Coding: Physical Therapy - Home Health CMS LCD
- 98972 CMS LCD: Billing and Coding: Physical Therapy - Home Health CMS LCD
Convert G54.7 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 |
|---|---|---|
| G54.7 | 3536 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To G54.7
Other codes in section G50-G59 (Nerve, nerve root and plexus disorders).
ICD-10 G54.7, Billing FAQ
Is ICD-10 code G54.7 billable? +
Yes, G54.7 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 G54.7? +
ICD-10 G54.7 includes: Phantom limb syndrome NOS.
Does G54.7 affect Medicare Advantage HCC risk adjustment? +
Yes. G54.7 maps to CMS-HCC v28 category 189. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with G54.7? +
Procedures frequently paired with G54.7 include: G0151, G0159, G2168, G0157, 98977.
What ICD-9 codes does G54.7 map to? +
Per CMS GEMs, G54.7 maps to ICD-9 codes: 3536. 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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