G12.25: Progressive spinal muscle atrophy

Risk adjustment

G12.25 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 190 Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease, Spinal Muscular Atrophy1.175 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

G12.25 is named in 22 Medicare coverage policies: 22 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52494High Frequency Chest Wall Oscillation Devices - Policy Article
• A52510Mechanical In-exsufflation Devices - Policy Article
• A52996Billing and Coding: Routine Foot Care
• A53057Billing and Coding: Home Health Occupational Therapy