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

ICD-10 I27.20

Billable / Specific HCC v28: 85

Pulmonary hypertension, unspecified

I27
Block
1
Synonyms
358
LCDs
20
Payer Policies
2
Linked CPTs

About ICD-10-CM I27.20

ICD-10-CM code I27.20 represents Pulmonary hypertension, unspecified. This is a billable/specific code in the Circulatory System chapter (block I27). The 2026 edition of ICD-10-CM I27.20 became effective on October 1, 2025.

Coding Tips for I27.20

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

HCC capture: document with MEAT each year

I27.20 is a CMS-HCC v28 risk-adjustment code (category 85). 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 I27.20. Per CMS ICD-10-CM Tabular 2026.

  • Pulmonary hypertension NOS

Medicare Advantage HCC Impact

CMS-HCC v28 (current)
Category 85
ESRD-HCC
Category 85
RxHCC (Part D)
Category 85

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 I27.20

Local Coverage Determinations (LCDs) from CMS MACs that list I27.20 as a covered diagnosis.

358 LCDs

Showing top 10 of 358 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94660 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94726 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94664 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94618 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94772 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94642 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT G0238 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94004 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94668 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94680 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing I27.20.

20 policies

1 Cigna

Plasma Brain Natriuretic Peptide in the Outpatient Setting - (0028)
Policy ID: MM_0028

5 Medicare

Nebulizers - Policy Article
Policy ID: ART-52466
Billing and Coding: Cardiac Catheterization and Coronary Angiography
Policy ID: ART-52850
Billing and Coding: Bariatric Surgery Coverage
Policy ID: ART-53026
Billing and Coding: Bariatric Surgery for Treatment of Co-Morbidities Conditions Related to Morbid Obesity
Policy ID: ART-54923
Billing and Coding: Cardiac Radionuclide Imaging
Policy ID: ART-56476

2 Aetna

Nitric Oxide, Inhalational (INO)
Policy ID: CPB-0518
Magnetic Resonance Imaging of the Cardiovascular System - Cardiac MRI
Policy ID: CPB-0520

CPT Codes Commonly Billed with I27.20

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

2 linkages
  • 93306 Echo with Doppler — heart failure, cardiomyopathy, mitral/aortic/tricuspid valve disease, chest pain, dyspnea, CAD, pulmonary HTN, ASD, VSD, congenital valve Cardiology
  • 71260 CT chest with contrast — pulmonary embolism, chest pain, dyspnea, wheezing, pulmonary HTN, lung cancer, nodule, thrombophilia Radiology

ICD-10 I27.20, Billing FAQ

Is ICD-10 code I27.20 billable? +

Yes, I27.20 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 I27.20? +

ICD-10 I27.20 includes: Pulmonary hypertension NOS.

Does I27.20 affect Medicare Advantage HCC risk adjustment? +

Yes. I27.20 maps to CMS-HCC v28 category 85. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What CPT codes are commonly billed with I27.20? +

Procedures frequently paired with I27.20 include: 93306, 71260.

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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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