2027 ICD-10-CM Diagnosis Code G54.6Phantom limb syndrome with pain

ICD-10-CM Codes›G00–G99›G50-G59›G54

ICD-10-CM G54.6
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

G54.6 is a billable ICD-10-CM diagnosis code for phantom limb syndrome with pain. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 73 through 74. Coders also document this condition as phantom limb. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Nerve and nerve root disorders.

For Medicare Advantage risk adjustment, G54.6 maps to CMS-HCC Category 409 (Amputation Status, Lower Limb/Amputation Complications) under the V28 model, adding a risk factor of about 0.598 for a community, non-dual, aged beneficiary in payment year 2027.

Code Identity

ICD-10-CM Code
G54.6
Billable Status
Yes — Valid for Submission
Code Describes
Phantom limb syndrome with pain
Short Description
Phantom limb syndrome with pain
Same as the full description in the CMS dataset.
Parent Code
G54
Nerve root and plexus disorders

Code Classification

ChapterG00–G99Diseases of the nervous system
SectionG50-G59Nerve, nerve root and plexus disorders
CategoryG54Nerve root and plexus disorders
This CodeG54.6Phantom limb syndrome with pain

Medicare Risk Adjustment (HCC)Billing

G54.6 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.

CMS-HCC V28 Category (Payment Model)
HCC 409— Amputation Status, Lower Limb/Amputation Complications
Payment HCC · PY 2027 one of 44 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.598
community, non-dual, aged · ranges 0.284–0.844 across segments
Hierarchy
Superseded by HCC 263 and HCC 405
a more severe related category takes the payment when both are reported
Prior Model (CMS-HCC V24)
HCC 189
V24 retired V28 pays 100% of MA risk scores since PY 2026
Other CMS Models
PACE (CMS-HCC V22): HCC 189 · ESRD (V21): HCC 189 · ESRD (V24): HCC 189
ESRD V21 weights: 0.090 dialysis, 0.339–0.654 functioning graft · ESRD V24 weights: 0.081 dialysis, 0.396–0.831 functioning graft
Part D (RxHCC)
Not mapped
G54.6 does not risk-adjust in the RxHCC prescription drug model

Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Phantom limb
  • Phantom limb syndrome with pain
  • Phantom pain
  • Phantom pain following amputation of lower limb
  • Phantom pain following amputation of penis
  • Phantom pain following amputation of upper limb
  • Phantom pain following excision of eye

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to G54.6: its own notes plus those printed at G54, block G50-G59, and Chapter 6. A note printed at a category, block or chapter applies to every code under it.

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From G54 Nerve root and plexus disorders applies to 10 codes
  • 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.-)
From Block G50-G59 Nerve, nerve root and plexus disorders applies to 106 codes
  • current traumatic nerve, nerve root and plexus disorders - see Injury, nerve by body region
  • neuralgia NOS (M79.2)
  • neuritis NOS (M79.2)
  • peripheral neuritis in pregnancy (O26.82-)
  • radiculitis NOS (M54.1-)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Chapter 6 (G00-G99) Diseases of the nervous system applies to 700 codes
  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name G54.6, its category, or a range that includes it.

Excludes2 2

These codes carry an Excludes2 note naming G54.6: its condition is not part of those codes, and both may be reported when the patient has both.

  • G89 Pain, not elsewhere classified
    phantom limb syndrome with pain (G54.6)
  • T87.89 Other complications of amputation stump
    phantom limb syndrome (G54.6-G54.7)

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR NVS017
Nerve and nerve root disorders
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Limb Loss

People can lose all or part of an arm or leg for many reasons. Common ones include:

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert G54.6 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
353.6 Phantom limb (syndrome)
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About G54.6Overview

What is the ICD-10 code for phantom limb syndrome with pain?

The ICD-10-CM code for phantom limb syndrome with pain is G54.6 (sometimes written as G546). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is G54.6 (Nerve root and plexus disorders) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report phantom limb syndrome with pain on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does G54.6 group to?

When phantom limb syndrome with pain is the principal diagnosis on an inpatient stay, it groups to MS-DRG 74, 73, with relative weights from 1.0172 to 1.5773 depending on complications. Higher weights mean higher Medicare reimbursement.

Can G54.6 be reported with M79.2?

Not as a rule. The Excludes1 note at G54, which applies to G54.6, lists "neuralgia or neuritis NOS (M79.2)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).

What is the ICD-9 equivalent of G54.6?

Under the General Equivalence Mappings, phantom limb syndrome with pain converts to ICD-9-CM 353.6 (phantom limb (syndrome)). The mapping is approximate, so confirm the match fits the documentation.

What HCC is G54.6?

G54.6 (phantom limb syndrome with pain) maps to CMS-HCC Category 409 (Amputation Status, Lower Limb/Amputation Complications), commonly written as HCC 409, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 189 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.

Does G54.6 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, G54.6 adds a risk adjustment factor of about 0.598 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.284 to 0.844 depending on the payment segment). A more severe related category (HCC 263 and HCC 405) supersedes it when both are reported. See the full factor table on the HCC 409 category page.