PCOS ICD-10 Code E28.2 (FY2027): Polycystic Ovary Syndrome Coding

FY2027 update: This guide reflects the FY2027 ICD-10-CM code set, effective October 1, 2026. However, code E28.2 did not change for FY2027.

New to medical coding? See how our CPC Training gets you certified.

How do you code and bill for PCOS?

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting millions of women of reproductive age. Because it involves a wide range of symptoms and comorbidities, accurate medical coding for polycystic ovary syndrome is essential to ensure proper reimbursement, reduce claim denials, and maintain compliance.

For this reason, below is a comprehensive guide for coding and billing PCOS-related encounters.

What is PCOS?

PCOS involves a hormonal imbalance that affects ovulation. For example, common clinical features include:

• Irregular menstrual cycles

• Hyperandrogenism (acne, hirsutism)

• Polycystic ovaries on ultrasound

• Obesity

• Insulin resistance

• Infertility

In addition, PCOS often coexists with conditions such as:

• Type 2 diabetes

• Metabolic syndrome

• Cardiovascular disease

• Depression and anxiety

What is the ICD-10 code for PCOS?

E28.2 – Polycystic ovarian syndrome

In short, this is the primary code for documenting PCOS. Use it when the provider diagnoses PCOS by clinical evaluation, lab results, and/or imaging.

What other diagnosis codes do you report with PCOS?

Since PCOS can present with a variety of symptoms, you may need to code for associated conditions as well:

• E66.9 – Obesity, unspecified

• E11.9 – Type 2 diabetes mellitus without complications

• N92.5 – Other specified irregular menstruation

• L68.0 – Hirsutism

• L70.0 – Acne vulgaris

• F32.9 – Major depressive disorder, single episode, unspecified

• F41.9 – Anxiety disorder, unspecified

• N97.9 – Female infertility, unspecified

• N97.0 – Female infertility associated with anovulation

• E88.819 – Insulin resistance, unspecified

• E88.818 – Other insulin resistance

• E88.810 – Metabolic syndrome

Obesity and BMI: When the provider documents obesity, also report the BMI from category Z68. You may take the BMI value from other clinicians’ documentation, but the provider must document the weight diagnosis itself.

Therefore, always ensure that clinical documentation in the medical record supports each diagnosis.

What CPT and HCPCS codes apply to PCOS management?

While there isn’t a specific CPT code for PCOS itself, management and treatment may involve several services:

Evaluation and Management (E/M) Codes

• 99202–99215 – Office or outpatient visits (based on time or medical decision-making)

Diagnostic Testing

• 76830 – Transvaginal pelvic ultrasound

• 80061 – Lipid panel

• 84443 – TSH (thyroid-stimulating hormone)

• 84403 – Total testosterone

• 82670 – Estradiol

• 83036 – Hemoglobin A1c

Treatment Services

• 96372 – Therapeutic, prophylactic, or diagnostic injection

• J1050 – Medroxyprogesterone acetate (Depo-Provera), per 1 mg

• S9480 – Intensive outpatient psychiatric services, per diem (if treating mental health)

Tip: In addition, always verify payer-specific policies for diagnostic tests and procedures related to PCOS.

What documentation supports PCOS coding?

• Use the Most Specific Code: Always choose the most accurate diagnosis code based on documentation. Avoid unspecified codes when more specific options exist.

• Link Diagnoses with Services: Also make sure the claim form clearly links all tests and procedures to the appropriate diagnosis.

• Support with Documentation: In addition, ensure the medical record includes:

  • Chief complaint and symptoms

  • Relevant history and physical exam findings

  • Lab/imaging results

  • Assessment and treatment plan

• Include Comorbid Conditions: These can affect medical decision-making and therefore justify higher E/M levels.

• Check for Prior Authorization: Some insurance plans require prior approval for imaging (e.g., pelvic ultrasound) or endocrinology consults.

• Consider Preventive Services: If addressing long-term risks (e.g., diabetes screening), include appropriate screening codes like Z13.1 (screening for diabetes).

What are common PCOS coding mistakes?

• Undercoding: Not capturing all relevant diagnoses, such as associated obesity or mental health conditions.

• Overcoding: Reporting services even though the record does not document them or they are not medically necessary.

• Inconsistent Documentation: Discrepancies between provider notes and submitted codes can also trigger audits.

• Missing Z Codes: Forgetting to add contextual codes like Z31.41 (encounter for fertility testing) when relevant.

Related reading: Medical Coding Bundling and Upcoding Guidelines

In summary, PCOS is a multifaceted condition that demands a nuanced approach to coding and billing. By using accurate ICD-10 and CPT codes and ensuring complete documentation, healthcare providers and billing teams can streamline reimbursement, reduce denials, and support better patient care.

Frequently asked questions

What is the ICD-10 code for PCOS?

Report polycystic ovarian syndrome with E28.2. Also, the code did not change for FY2027.

Is there a CPT code for PCOS?

No. CPT describes services rather than conditions. Instead, report PCOS care with the E/M visit, lab, imaging and treatment codes for the services performed, linked to E28.2 and any related diagnoses.

How do you code insulin resistance with PCOS?

Report E28.2 for PCOS and add a code from E88.81- when the provider documents insulin resistance or metabolic syndrome, such as E88.819 for insulin resistance, unspecified.

What CPT code reports a total testosterone test?

Total testosterone is 84403. In contrast, free testosterone is 84402. Do not confuse these with 84153, which is total PSA.

Which infertility code applies to PCOS related infertility?

When the provider documents infertility due to anovulation, report N97.0. Use N97.9 only when the type of infertility is not specified.

Source: National Institutes of Health research review of polycystic ovary syndrome (PubMed Central)

Ready to become a certified medical coder? Our online CPC certification training prepares you for the AAPC CPC exam with a credentialed instructor. Many students train at little or no cost through medical coding scholarships and WIOA grants available in 30+ states.