2027 ICD-10-CM Diagnosis Code Z68.55Body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age

ICD-10-CM Codes›Z00–Z99›BMI›Z68

ICD-10-CM Z68.55
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

Z68.55 is a billable ICD-10-CM diagnosis code for body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 640 through 641. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 9 closely related codes. The code is not accepted as a principal diagnosis by the Medicare Code Editor and exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Obesity.

Code Identity

ICD-10-CM Code
Z68.55
Billable Status
Yes — Valid for Submission
Code Describes
Body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age
Short Description
Body mass index ped, 120% 95% for age to < 140% 95% for age
Parent Code
Z68.5
Body mass index [BMI] pediatric

Code Classification

ChapterZ00–Z99Factors influencing health status and contact with health services
SectionBMIBody mass index (Z68)
CategoryZ68Body mass index [BMI]
This CodeZ68.55Body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age

Code EditsBilling

Medicare Code Editor checks that affect claim validity for Z68.55.

Unacceptable principal diagnosis
There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Present on Admission (POA)Billing

Z68.55 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Body mass index (BMI) (Z68).

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to Z68.55: its own notes plus those printed at Z68 and Chapter 21. A note printed at a category, block or chapter applies to every code under it.

Notes

General instructions on how these codes are used.

From Z68 Body mass index [BMI] applies to 33 codes
  • BMI adult codes are for use for persons 20 years of age or older
  • BMI pediatric codes are for use for persons 2-19 years of age.
  • These percentiles are based on the growth charts published by the Centers for Disease Control and Prevention (CDC)
From Chapter 21 (Z00-Z99) Factors influencing health status and contact with health services applies to 1,425 codes
  • Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
  • (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
  • (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.

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

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name Z68.55, its category, or a range that includes it.

Use Additional Code 5

These codes say to use an additional code from the note, and Z68.55 is one of the codes named.

  • E66 Overweight and obesity
    code to identify body mass index (BMI), if known, for adults (Z68.1-Z68.45) or pediatrics (Z68.5-) names Z68.5-, which includes this code
  • E88.82 Obesity due to disruption of MC4R pathway
    code to identify body mass index (BMI), if known (Z68.-) names Z68.-, which includes this code
  • R63.6 Underweight
    code to identify body mass index (BMI), if known (Z68.-) names Z68.-, which includes this code
  • Z15.2 Genetic susceptibility to obesity
    code to identify body mass index (BMI), if known (Z68.-) names Z68.-, which includes this code
  • Z71.3 Dietary counseling and surveillance
    code to identify body mass index (BMI), if known (Z68.-) names Z68.-, which includes this code

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 END009
Obesity
Default principal diagnosis: inpatient No · outpatient No

Code History & ChangesHistory

Replacement Z68.55 replaces the following previously assigned code(s):

  • Z68.54 - BMI pediatric, greater than or equal to 95% for age
  • Z68.54 - Body mass index ped, 95% for age to < 120% of 95% for age
  • Z68.54 - Body mass index pediatric, > or equal to 95% for age
FY 2025AddedAdded to the ICD-10-CM code setEffective October 1, 2024.
FY 2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About Z68.55Overview

Is Z68.55 (Body mass index [BMI] pediatric) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does Z68.55 group to?

On inpatient claims, body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age maps to MS-DRG 641, 640, with relative weights from 0.7864 to 1.3392 depending on complications. Higher weights mean higher Medicare reimbursement.

Is Z68.55 a CC or MCC?

CMS lists Z68.55 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 9 closely related codes in its exclusion list.

Can Z68.55 be a principal diagnosis?

No. The Medicare Code Editor rejects this code as a principal diagnosis because body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.

Is Z68.55 exempt from POA reporting?

Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age on inpatient claims. The code appears in the Body mass index (BMI) (Z68) range of the CMS exempt list.