CPT (Current Procedural Terminology) codes are five-digit numeric codes used to describe medical, surgical, and diagnostic services. They are maintained by the American Medical Association and used by healthcare providers, insurers, and Medicare for billing and reimbursement.

What is the difference between facility and non-facility rates?

Non-facility (office) rates are what Medicare pays when a service is performed in a physician's office. Facility rates are lower because when a service is performed in a hospital or ambulatory surgery center, the facility bills separately for overhead costs like equipment and supplies.

RVU stands for Relative Value Unit. Medicare uses RVUs to measure the value of physician services based on three components: physician work, practice expense, and malpractice cost. Total RVUs are multiplied by the conversion factor ($33.40 in 2026) to calculate the Medicare payment amount.

Is I63.111 a billable ICD-10-CM code?

Yes. I63.111 (Cerebral infarction due to embolism of right vertebral artery) is a billable/specific ICD-10-CM code and can be reported on a claim when the documentation supports it.

What HCC does I63.111 map to?

I63.111 maps to HCC249 (Ischemic or Unspecified Stroke) in the CMS-HCC V28 risk-adjustment model (Medicare Advantage / Part C) for payment year 2026. Risk-adjustable diagnoses must be documented and resubmitted each year — and survive the CMS-HCC hierarchy and edits — to count toward a member's risk score.

ICD-10-CM · I00–I99BillableHCC249

ICD-10-CM Code I63.111

Cerebral infarction due to embolism of right vertebral artery

Source: CMS ICD-10-CM FY2026Effective October 1, 2025Reviewed by the D3rx Clinical Billing Team

Diagnosis information

Billable

Yes

Valid for claim submission

Chapter

I00–I99

Diseases of the circulatory system

Risk adjustment

HCC

HCC249

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HCC risk adjustment (CMS-HCC V28)

HCC249Ischemic or Unspecified Stroke

Model CMS-HCC V28Payment year 2026

In CMS's Hierarchical Condition Category (HCC) model — the risk-adjustment model for Medicare Advantage (Part C) — a documented and submitted I63.111 may contribute to a member's risk score (subject to the CMS-HCC hierarchy and edits), which helps drive the plan's capitated payment for that patient. To count, the diagnosis must be supported to the MEAT standard (Monitored, Evaluated, Assessed, Treated) and reported on an eligible face-to-face encounter at least once each calendar year — risk scores reset annually.

More codes in the I63 category

Other billable ICD-10-CM codes in the same category as I63.111. Coding to the highest specificity the documentation supports is what keeps a claim clean — pick the child code that most precisely matches the diagnosis.

I63.00Cerebral infarction due to thrombosis of unspecified precerebral artery
I63.011Cerebral infarction due to thrombosis of right vertebral artery
I63.012Cerebral infarction due to thrombosis of left vertebral artery
I63.013Cerebral infarction due to thrombosis of bilateral vertebral arteries
I63.019Cerebral infarction due to thrombosis of unspecified vertebral artery
I63.02Cerebral infarction due to thrombosis of basilar artery
I63.031Cerebral infarction due to thrombosis of right carotid artery
I63.032Cerebral infarction due to thrombosis of left carotid artery
I63.033Cerebral infarction due to thrombosis of bilateral carotid arteries
I63.039Cerebral infarction due to thrombosis of unspecified carotid artery
I63.09Cerebral infarction due to thrombosis of other precerebral artery
I63.10Cerebral infarction due to embolism of unspecified precerebral artery

Documentation & coding notes

I63.111 is a billable/specific ICD-10-CM code — it can be reported as a primary or secondary diagnosis when the documentation supports it. Code to the highest level of specificity the record allows.
I63.111 is risk-adjustable: it maps to HCC249 in the CMS-HCC V28 model (payment year 2026), the risk-adjustment model for Medicare Advantage (Part C). For the diagnosis to contribute to a member's risk score it must survive the CMS-HCC hierarchy and edits, be documented to the MEAT standard (Monitored, Evaluated, Assessed, Treated), and be submitted on an eligible face-to-face encounter at least once per calendar year.
I63.111 specifies laterality. Confirm the documented side matches the code — a laterality mismatch between the note and the claim is a frequent denial and audit target.
Always verify the code against the current ICD-10-CM Official Guidelines and the payer's coverage policy before submitting — coverage, medical necessity edits, and sequencing rules vary by payer.

Related I00–I99 codes

I10 I50.9 I48.91 I25.10 I63.9 I11.0 I69.30

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Medical coding disclaimer

ICD-10-CM codes and descriptions shown are from the CMS FY2026 official code set and HCC mappings from the CMS-HCC V28 model (payment year 2026), shown for educational reference. Official Guidelines, payer coverage, medical-necessity edits, and sequencing rules vary. Always verify with the current ICD-10-CM Official Guidelines and the payer before submitting claims. D3rx is not responsible for coding or billing outcomes.