G54.6

G54.6: Phantom limb syndrome with pain

Billable / specific codeICD-10-CM

G54.6 is a billable, specific ICD-10-CM code for phantom limb syndrome with pain. It is valid for submission on a claim.

Check G54.6 with the rest of the claim: free scrubber

Excludes1 inherited from the categories above G54.6

A category’s note binds every code beneath it.

Written on G54: Nerve root and plexus disorders

current traumatic nerve root and plexus disorders - see nerve injury by body region
intervertebral disc disorders (M50-M51)
neuralgia or neuritis NOS (M79.2)
neuritis or radiculitis brachial NOS (M54.13)
neuritis or radiculitis lumbar NOS (M54.16)
neuritis or radiculitis lumbosacral NOS (M54.17)
neuritis or radiculitis thoracic NOS (M54.14)
radiculitis NOS (M54.10)
radiculopathy NOS (M54.10)
spondylosis (M47.-)

Risk adjustment

G54.6 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 409 Amputation Status, Lower Limb/Amputation Complications0.598 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

G54.6 is named in 16 Medicare coverage policies: 16 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A53057Billing and Coding: Home Health Occupational Therapy
A53058Billing and Coding: Home Health Physical Therapy
A53064Billing and Coding: Outpatient Occupational Therapy
A53065Billing and Coding: Outpatient Physical Therapy

Alphabetic index entries that lead here

Phantom limb syndrome›with pain
Syndrome›phantom limb›with pain

Code history

Unchanged in every release from FY2024 to FY2027.