Geriatric Medicine ICD-10 Codes & CPT Codes

Geriatric medicine involves the diagnosis and management of complex, multi-system conditions in older adults including dementia, falls, polypharmacy, osteoporosis, and frailty. This page covers the top ICD-10-CM (FY2026, effective Oct 1, 2025) and CPT 2026 codes used by geriatricians and geriatric care specialists across the US, with select new FY2027 ICD-10-CM codes (effective Oct 1, 2026) noted where added.

FY 2027 ICD-10-CM (CMS, eff. 10/1/2026) · CPT 2026 (AMA) · All codes verified billable · Last verified: October 2026

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Top ICD-10 Codes for Geriatric Medicine

ICD-10 Code Description Billable
G30.9 Alzheimer’s disease, unspecified ✓
F03.90 Unspecified dementia without behavioral disturbance ✓
G20 Parkinson’s disease ✓
I10 Essential (primary) hypertension ✓
E11.9 Type 2 diabetes mellitus without complications ✓
M81.0 Age-related osteoporosis without current pathological fracture ✓
I50.9 Heart failure, unspecified ✓
E78.5 Hyperlipidemia, unspecified ✓
R41.3 Other amnesia ✓
R26.9 Unspecified abnormalities of gait and mobility ✓
R41.81 Age-related cognitive decline ✓
Z96.641 Presence of right artificial hip joint ✓
I25.10 Atherosclerotic heart disease of native coronary artery without angina ✓
R54 Age-related physical debility (frailty) ✓
Z00.00 Encounter for general adult medical examination without abnormal findings ✓
G30.0 Alzheimer’s disease with early onset ✓
G30.1 Alzheimer’s disease with late onset ✓
F03.91 Unspecified dementia with behavioral disturbance ✓
F01.50 Vascular dementia without behavioral disturbance ✓
M80.00XA Age-related osteoporosis with current pathological fracture, unspecified site ✓
R62.7 Adult failure to thrive ✓
E66.9 Obesity, unspecified ✓
F32.9 Major depressive disorder, single episode, unspecified ✓
F41.1 Generalized anxiety disorder ✓
N39.0 Urinary tract infection, site not specified ✓
R33.9 Retention of urine, unspecified ✓
I63.9 Cerebral infarction, unspecified ✓
G45.9 Transient cerebral ischemic attack, unspecified ✓
J44.1 Chronic obstructive pulmonary disease with acute exacerbation ✓
E03.9 Hypothyroidism, unspecified ✓
D64.9 Anaemia, unspecified ✓
Z79.01 Long-term (current) use of anticoagulants ✓
M25.561 Pain in right knee ✓
G47.33 Obstructive sleep apnea (adult) ✓
R41.0 Disorientation, unspecified ✓
G40.909 Epilepsy, unspecified, not intractable, without status epilepticus ✓
K21.0 Gastro-esophageal reflux disease with esophagitis ✓
N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms ✓
L89.90 Pressure ulcer of unspecified site, unspecified stage ✓
Z68.41 Body mass index (BMI) 40.0-44.9, adult ✓
F01.51 Vascular dementia, unspecified severity, with behavioral disturbance ✓
G30.8 Other Alzheimer’s disease ✓
F03.911 Unspecified dementia, unspecified severity, with agitation ✓
F06.70 Mild neurocognitive disorder due to known physiological condition, without behavioral disturbance ✓
I48.91 Unspecified atrial fibrillation ✓
I48.11 Longstanding persistent atrial fibrillation ✓
N18.3 Chronic kidney disease, stage 3 (moderate) ✓
N18.4 Chronic kidney disease, stage 4 (severe) ✓
E11.65 Type 2 diabetes mellitus with hyperglycemia ✓
E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified ✓
M54.50 Low back pain, unspecified ✓
M47.816 Spondylosis with radiculopathy, lumbar region ✓
R00.0 Tachycardia, unspecified ✓
R55 Syncope and collapse ✓
R60.9 Edema, unspecified ✓
Z87.39 Personal history of other endocrine, nutritional and metabolic diseases ✓
Z96.651 Presence of right artificial knee joint ✓
Z96.652 Presence of left artificial knee joint ✓
E55.9 Vitamin D deficiency, unspecified ✓
E53.8 Deficiency of other specified B group vitamins ✓
I73.9 Peripheral vascular disease, unspecified ✓
G89.29 Other chronic pain ✓
Z91.19 Patient’s noncompliance with medical treatment, unspecified ✓
F10.10 Alcohol abuse, uncomplicated ✓
Z87.891 Personal history of nicotine dependence ✓
Z91.81 History of falling ✓
Z68.18 Body mass index (BMI) 18.4 or less, adult — new FY2027 code, effective 10/1/2026 ✓
Z68.19 Body mass index (BMI) 18.5–19.9, adult — new FY2027 code, effective 10/1/2026 ✓

Source: CMS ICD-10-CM Official Code Set FY 2026 (includes select FY2027 codes effective October 1, 2026, marked accordingly above)

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Common CPT Codes for Geriatric Medicine Billing

CPT Code Description Medicare Rate* Common Modifiers
99202 Office visit, new patient, low complexity ~$75 -25, -57
99203 Office visit, new patient, moderate complexity ~$118 -25, -57
99204 Office visit, new patient, moderate-high complexity ~$177 -25, -57
99205 Office visit, new patient, high complexity ~$237 -25, -57
99213 Office visit, established patient, low complexity ~$95 -25, -57
99214 Office visit, established patient, moderate complexity ~$136 -25, -57
99215 Office visit, established patient, high complexity ~$192 -25, -57
G0438 Annual wellness visit; initial visit ~$174 None (Medicare only)
G0439 Annual wellness visit; subsequent visit ~$138 None (Medicare only)
99347 Home visit, established patient, low complexity ~$46 -25
99348 Home visit, established patient, moderate complexity ~$79 -25
99349 Home visit, established patient, moderate-high complexity ~$132 -25
99350 Home visit, established patient, high complexity ~$193 -25
96372 Therapeutic/prophylactic/diagnostic injection; SC or IM ~$15 -59
99483 Cognitive assessment and care plan services ~$293 Standalone
99487 Complex chronic care management, 60+ min/month ~$144 None
99489 Complex chronic care management, each additional 20 min ~$78 Add-on to 99487
G0506 Comprehensive assessment for chronic care management ~$66 Add-on to AWV

*Approximate 2026 CMS national non-facility rate. Rates vary by geography, setting, and payer contract. Refer to the CMS Physician Fee Schedule for official rates.

Top Denial Reasons for Geriatric Medicine Claims

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Insufficient Medical Necessity Documentation

Claims for complex E&M visits (99214-99215) are denied when chart notes fail to document time spent or MDM complexity. Ensure visit notes explicitly state total time or all three MDM elements: problems, data reviewed, and risk of complications.

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Missing Modifier -25 for Same-Day E&M and Procedure

When a therapeutic injection (96372) is billed on the same day as an E&M visit, modifier -25 must be appended to the E&M code to show the visit was separately identifiable. Omitting -25 routinely triggers automatic bundling denials.

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Annual Wellness Visit Billed with Wrong Code (G0438 vs G0439)

G0438 (initial AWV) can only be billed once per Medicare beneficiary lifetime; subsequent years require G0439. Billing G0438 twice results in a frequency denial. Verify eligibility history before scheduling to select the correct code.

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Chronic Care Management Billed Without Required Documentation

CPT 99487/99489 require documented patient consent, a comprehensive care plan, and minimum 60 minutes of clinical staff time per calendar month. Claims denied for CCM typically lack the care plan in the record or the time log supporting the threshold.

Geriatric Medicine Billing & Coding Tips

  • Document all active chronic conditions at every visit — geriatric patients with 5+ conditions are the highest-value HCC capture opportunity in value-based care contracts.
  • Dementia codes (F01.x, F02.x, F03.x) must specify whether behavioral disturbance is present or absent — ‘without behavioral disturbance’ (F03.90) vs. ‘with behavioral disturbance’ (F03.91) significantly affects severity documentation.
  • Annual Wellness Visit (AWV) CPT G0438/G0439 is distinct from a preventive E&M and requires a Health Risk Assessment — both can be billed in the same year when scheduled at the correct interval.
  • Fall risk assessment and medication reconciliation for polypharmacy should be documented at each encounter as they are HEDIS measures affecting quality bonuses.

Frequently Asked Questions

What is the ICD-10 code for Alzheimer’s dementia?

G30.9 is Alzheimer’s disease, unspecified. For coding dementia due to Alzheimer’s, use F02.80 (Dementia in other diseases classified elsewhere, without behavioral disturbance) or F02.81 (with behavioral disturbance) as the primary manifestation code, with G30.9 as the etiology code — per ICD-10 convention, code the manifestation first.

What is the Annual Wellness Visit CPT code?

G0438 is the Initial Annual Wellness Visit (AWV) under Medicare. G0439 is for subsequent years. The AWV is NOT a physical exam — it requires a Health Risk Assessment, an updated medical and family history, and a 5–10 year preventive care screening schedule. It can be billed alongside an E&M with modifier -25 if a separate problem is addressed.

What is R54 used for?

R54 (Age-related physical debility) captures frailty in older adults — a clinically significant syndrome affecting functional independence, hospitalization risk, and care planning. It is particularly important for risk stratification under value-based care models.

How do I code osteoporosis with a fracture?

If the osteoporotic fracture is current, use M80.0x1A (age-related osteoporosis with current pathological fracture, right side, initial encounter) or the appropriate site/side combination. M81.0 (without current fracture) is used when osteoporosis is present but no fracture has occurred.

How does OmniMD support geriatric care?

OmniMD’s Geriatric Medicine EHR includes cognitive assessment tools (MMSE, MoCA), polypharmacy reconciliation alerts, fall risk documentation templates (Morse Fall Scale), and value-based care dashboards for HEDIS measures.

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