G04.1: Tropical spastic paraplegia
G04.1 is a billable, specific ICD-10-CM code for tropical spastic paraplegia. It is valid for submission on a claim.
Check G04.1 with the rest of the claim: free scrubberExcludes1 inherited from the categories above G04.1
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above G04.1
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with G04.1
Their own Excludes1 notes name this code, so the conflict is not listed above.
- G03Meningitis due to other and unspecified causes
Risk adjustment
G04.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 182 Spinal Cord Disorders/Injuries0.478 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
G04.1 is named in 29 Medicare coverage policies: 29 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52465Knee Orthoses - Policy Article
- A53057Billing and Coding: Home Health Occupational Therapy
- A53058Billing and Coding: Home Health Physical Therapy
- A53064Billing and Coding: Outpatient Occupational Therapy
Alphabetic index entries that lead here
- Paraplegia›tropical spastic
- Paraplegia›spastic›tropical
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under G04
- G04.0Acute disseminated encephalitis and encephalomyelitis (ADEM)
- G04.2Bacterial meningoencephalitis and meningomyelitis, not elsewhere classified
- G04.3Acute necrotizing hemorrhagic encephalopathy
- G04.8Other encephalitis, myelitis and encephalomyelitis
- G04.9Encephalitis, myelitis and encephalomyelitis, unspecified