G25.81: Restless legs syndrome

The ICD-10-CM code for restless legs syndrome, the sensorimotor disorder marked by an urge to move the legs that worsens at rest and in the evening.

Billable

FY2027

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At a glance

Code Family

G25: Other extrapyramidal and movement disorders.

DRG Grouping

As a principal inpatient diagnosis, G25.81 groups to MS-DRG 056 or 057, Degenerative Nervous System Disorders with MCC or without MCC, in MDC 01 under the FY2027 MS-DRG v44 grouper.

HCC Mapping (v28)

None. G25.81 carries no HCC weight in CMS-HCC v28.

Condition

Restless legs syndrome

Billable

Yes. G25.81 is a valid code for HIPAA-covered transactions.

Family Specificity

G25.81 sits under G25.8, other specified extrapyramidal and movement disorders, and is the dedicated code for restless legs syndrome.

Which G25 code do I assign?

The G25 family splits on which movement disorder the provider names, not on how severe it is. Match the code to the named diagnosis, and reserve G25.81 for documentation that states restless legs syndrome, RLS or Ekbom syndrome.

When documentation says…

Code

Urge to move the legs, worse at rest, worse in the evening, relieved by movement

G25.81

Restless legs syndrome. The note must carry the diagnostic label restless legs syndrome, RLS or Ekbom syndrome, together with the sensory and motor findings that support it.

Periodic limb movements during sleep on polysomnography

G47.61

Periodic limb movement disorder, a sleep related movement disorder distinct from restless legs syndrome. An Excludes2 note applies. Both codes may be reported when each diagnosis is independently documented.

Action tremor with no identified etiology

G25.0

Essential tremor. The note must describe tremor on action rather than an urge to move the legs at rest.

Myoclonus documented

G25.3

Myoclonus. Drug-induced myoclonus is an inclusion term at G25.3, and a Use additional note there calls for the adverse effect code (T36–T50 with fifth or sixth character 5) to identify the drug.

Progressive muscle stiffness and spasm

G25.82

Stiff-man syndrome. The note must describe the stiffness and spasm pattern rather than an urge to move.

Movement disorder recorded without a stated type

G25.9

Extrapyramidal and movement disorder, unspecified. This is the residual code for a movement disorder named without further detail.

Tabular notes

EXCLUDES2

G47.6: Sleep related movement disorders. This Excludes2 note sits at category G25 and applies to G25.81, which carries no note of its own. Subcategory G47.6 carries the reciprocal Excludes2 note for restless legs syndrome (G25.81). The note means these conditions are not part of restless legs syndrome but may coexist with it. Periodic limb movement disorder (G47.61) is one code in that subcategory. When restless legs syndrome and a sleep related movement disorder are each independently diagnosed and documented, both G25.81 and the appropriate G47.6- code may be assigned.

FY2027: EFFECTIVE 1 OCTOBER 2026

G25.81 is unchanged in the FY2027 update. The FY2027 codes and tabular addenda change nothing in category G25. G25.81 carries no Excludes1 note, no Use Additional instruction and no Code First instruction in FY2027.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

None. G25.81 does not map to any HCC category in CMS-HCC v28.

Restless legs syndrome makes no RAF contribution. It does not affect Medicare Advantage risk scores.

Where restless legs syndrome is secondary to end stage renal disease (N18.6), risk adjustment capture runs through the underlying condition. The end stage renal disease code maps to HCC 326 in CMS-HCC v28.

V24 TO V28 TRANSITION

G25.81 carried no HCC weight in CMS-HCC v24 and carries none in v28. The move between models changes nothing for this code.

MS-DRG v44 (FY2027)

As a principal inpatient diagnosis, G25.81 groups to MS-DRG 056 or 057, Degenerative Nervous System Disorders with MCC or without MCC, in MDC 01 under the FY2027 MS-DRG v44 grouper.

MDC 01 is Diseases and Disorders of the Nervous System. A reported secondary MCC can move the case from MS-DRG 057 to MS-DRG 056. The pair has no with-CC tier.

Medicare and commercial payers

Medicare: G25.81 supports medical necessity for sleep studies when sleep disturbance from restless legs syndrome is the condition under evaluation.

Dopaminergic medications such as pramipexole and ropinirole are covered under Medicare Part D as oral prescription drugs.

WHERE SPECIFICITY IS LOST

Assigning G25.9 or G25.89 when the record names restless legs syndrome discards the dedicated code for the condition.

Reading the G47.6- Excludes2 note as an Excludes1 note suppresses a second reportable diagnosis. An Excludes2 note permits both codes when each condition is independently documented.

Omitting a documented secondary cause, such as iron deficiency anemia or end stage renal disease, drops a reportable condition. Of those two, only end stage renal disease (N18.6) maps to a v28 HCC.

Documentation checklist to support G25.81

Chart elements that support code selection and reduce specificity-driven denials.

A diagnosis of restless legs syndrome, RLS or Ekbom syndrome, stated in the provider's documentation.

The clinical basis for that diagnosis: an urge to move the legs or arms, sensory discomfort, worsening at rest, worsening in the evening, and improvement with movement.

The uncomfortable sensations as described, such as crawling, creeping, tingling or burning.

Any documented secondary cause, such as iron deficiency anemia, end stage renal disease or pregnancy. The underlying condition is coded additionally.

Where periodic limb movement disorder is also present, an independent statement of that diagnosis to support G47.61 alongside G25.81.

The effect on sleep, where a sleep study is ordered and G25.81 carries the medical necessity for that study.

For inpatient encounters, the medications given during the admission that could affect restless legs symptoms, such as antipsychotics, antihistamines or dopaminergic agents.

FAQ

Is G25.81 a billable code?

Yes. G25.81 is valid for HIPAA-covered transactions. It is a complete code and no further characters are required.

Can G25.81 and G47.61 be coded together?

Yes. Category G25 carries an Excludes2 note for sleep related movement disorders (G47.6-), and subcategory G47.6 carries an Excludes2 note for restless legs syndrome (G25.81). An Excludes2 note means the conditions are distinct but may coexist. Report both codes when restless legs syndrome and periodic limb movement disorder are each independently diagnosed and documented.

Does G25.81 map to an HCC?

No. G25.81 does not map to any HCC category in CMS-HCC v28, and it did not map to one in CMS-HCC v24. It makes no RAF contribution and does not affect Medicare Advantage risk scores.

What must the note show to support G25.81?

The provider must state a diagnosis of restless legs syndrome, RLS or Ekbom syndrome. The note should also record the clinical basis: an urge to move the legs with sensory discomfort, worse at rest, worse in the evening, and relieved by movement.

How do I sequence G25.81 when a secondary cause is documented?

Code both G25.81 and the underlying condition, such as iron deficiency anemia (D50.-) or end stage renal disease (N18.6). In pregnancy, a code from subcategory O99.35 is sequenced first under Guideline I.C.15.a.1. When the provider documents the pregnancy as incidental to the encounter, Z33.1, Pregnant state, incidental, is coded in place of any chapter 15 code. ICD-10-CM does not restrict co-coding restless legs syndrome with its etiologies. Sequence according to the reason for the encounter.

Does G25.81 work the same way inpatient and outpatient?

Outpatient, G25.81 is reported in neurology, sleep medicine and primary care for the diagnosis and management of restless legs syndrome. Inpatient, it is reported as a secondary diagnosis when another condition occasioned the admission. It stays clinically relevant inpatient when medications given during the admission, such as antipsychotics, antihistamines or dopaminergic agents, could affect symptoms.

What changed for G25.81 in FY2027?

G25.81 is unchanged in the FY2027 update, effective 1 October 2026. The FY2027 codes and tabular addenda change nothing in category G25.

What is the ICD-9-CM predecessor for G25.81?

The ICD-9-CM predecessor is code 333.94, restless legs syndrome. The GEM crosswalk maps 333.94 directly to G25.81.

Related codes

Codes in the same family as G25.81. Only codes with a published page render as links.

Sibling codes in the G25 family

G25.0: Essential tremor.
G25.3: Myoclonus.
G25.82: Stiff-man syndrome.
G25.89: Other specified extrapyramidal and movement disorders.
G25.9: Extrapyramidal and movement disorder, unspecified.

Additional codes to consider

Codes outside the G25 family considered alongside G25.81.

Companion: code alongside when documented

G47.61: Periodic limb movement disorder, reportable with G25.81 under the Excludes2 note when both are independently diagnosed.
O99.35-: Diseases of the nervous system complicating pregnancy, childbirth, and the puerperium, sequenced first when restless legs syndrome occurs in pregnancy, under Guideline I.C.15.a.1. When the provider documents the pregnancy as incidental to the encounter, Z33.1, Pregnant state, incidental, is coded in place of any chapter 15 code.

Consider instead

G25.89: Other specified extrapyramidal and movement disorders, where the note names a different specified movement disorder.
G25.9: Extrapyramidal and movement disorder, unspecified, where the note names no specific movement disorder.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software