I69.264 — Other paralytic syndrome following other nontraumatic intracranial hemorrhage affecting left non-dominant side

Risk adjustment

I69.264 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 254 Monoplegia, Other Paralytic Syndromes0.321 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

I69.264 is named in 10 Medicare coverage policies — 10 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

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