Is G04.1 a billable ICD-10-CM code?

Yes. G04.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does G04.1 sit in the tabular list?

Diseases of the nervous system (G00-G99), in the block Inflammatory diseases of the central nervous system (G00-G09).

What cannot be coded together with G04.1?

G04.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above G04.1 (G04) and apply to it just the same.

G04.1

G04.1 — Tropical spastic paraplegia

Billable / specific codeICD-10-CM

G04.1 is a billable, specific ICD-10-CM code for tropical spastic paraplegia. It is valid for submission on a claim.

Excludes1 inherited from the categories above G04.1

These are not written on G04.1, but they bind it: a note on a category applies to every code beneath it. Billing G04.1 with anything listed here is a denial.

Written on G04 — Encephalitis, myelitis and encephalomyelitis

encephalopathy NOS (G93.40)

Excludes2 inherited from the categories above G04.1

Also inherited, and the opposite of Excludes1: these conditions are not part of G04.1, but a patient can have both, so you may code both.

Written on G04 — Encephalitis, myelitis and encephalomyelitis

acute transverse myelitis (G37.3)
alcoholic encephalopathy (G31.2)
multiple sclerosis (G35-)
myalgic encephalomyelitis (G93.32)
subacute necrotizing myelitis (G37.4)
toxic encephalitis (G92.8)
toxic encephalopathy (G92.8)

Other codes that can never be billed with G04.1

These codes carry an Excludes1 note pointing at G04.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading G04.1 alone.

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.

Medicare coverage

G04.1 is named in 32 Medicare coverage policies — 32 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52465Knee Orthoses - Policy Article
A53057Billing and Coding: Home Health Occupational Therapy
A53058Billing and Coding: Home Health Physical Therapy
A53064Billing and Coding: Outpatient Occupational Therapy

How G04.1 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to G04.1.

Paraplegia›tropical spastic
Paraplegia›spastic›tropical

Code history

G04.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share G04. If G04.1 is not quite right, the correct code is usually one of these.

Questions about G04.1

Is G04.1 a billable ICD-10-CM code?: Yes. G04.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does G04.1 sit in the tabular list?: Diseases of the nervous system (G00-G99), in the block Inflammatory diseases of the central nervous system (G00-G09).
What cannot be coded together with G04.1?: G04.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above G04.1 (G04) and apply to it just the same.