Medicare Risk Adjustment Eligible CPT/HCPCS Codes

Below are links to the list of Medicare Risk Adjustment Eligible CPT/HCPCS Codes. There are files for various years. Find the CPT code on the list to verify if those visit types are risk adjustment eligible.

outpatient

inpatient

skilled nursing facilities

Medicare Risk Adjustment Eligible CPT/HCPCS Codes

https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/risk-adjustors-items/cpt-hcpcs

Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations. The information presented herein is for general informational purposes only and is accurate as of the date of publication.

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This is a link to further information on the Medicare Preventive Services. The layout of it reminds me of a bingo card! Medicare Learning Network is the educational arm of Centers for Medicare and Medicaid Service (CMS). Remember this is further information on different types of screenings available to Medicare beneficiaries. https://www.cms.gov/Medicare/ Prevention/PrevntionGenInfo/ medicare-preventive-services/ MPS-QuickReferenceChart-1. html#AWV Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations. The information presented herein is for general informational purposes only and is accurate as of the date of publication.

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Signature requirements

The Medicare Program Integrity Manual contains the guidance around signature requirements. They are found in chapter 3. 3.3.2.4 - Signature Requirements This material was also covered in the Part AB November 2025 webinar by Noridian entitled: Signature Requirements Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations. The information presented herein is for general informational purposes only and is accurate as of the date of publication.

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