ICD-10 B01.11
Billable / Specific MCCVaricella encephalitis and encephalomyelitis
About ICD-10-CM B01.11
ICD-10-CM code B01.11 represents Varicella encephalitis and encephalomyelitis. This is a billable/specific code in the Infectious and Parasitic Diseases chapter (block B01). The 2026 edition of ICD-10-CM B01.11 became effective on October 1, 2025.
Coding Tips for B01.11
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
B01.11 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under B01.11. Per CMS ICD-10-CM Tabular 2026.
- Postchickenpox encephalitis and encephalomyelitis
Inpatient DRG Impact, MCC
codes Varicella encephalitis and encephalomyelitis. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for B01.11
Local Coverage Determinations (LCDs) from CMS MACs that list B01.11 as a covered diagnosis.
Showing top 10 of 588 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing B01.11.
5 Medicare
CPT Codes Commonly Billed with B01.11
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 95708 CMS LCD: Billing and Coding: Special Electroencephalography CMS LCD
- 95721 CMS LCD: Billing and Coding: Special Electroencephalography CMS LCD
- 95719 CMS LCD: Billing and Coding: Special Electroencephalography CMS LCD
- 95813 CMS LCD: Billing and Coding: Special Electroencephalography CMS LCD
- 95822 CMS LCD: Billing and Coding: Special Electroencephalography CMS LCD
- 95717 CMS LCD: Billing and Coding: Special Electroencephalography CMS LCD
- 95812 CMS LCD: Billing and Coding: Special Electroencephalography CMS LCD
- 95700 CMS LCD: Billing and Coding: Special Electroencephalography CMS LCD
- 95705 CMS LCD: Billing and Coding: Special Electroencephalography CMS LCD
Convert B01.11 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| B01.11 | 0520 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To B01.11
Other codes in section B00-B09 (Viral infections characterized by skin and mucous membrane lesions).
ICD-10 B01.11, Billing FAQ
Is ICD-10 code B01.11 billable? +
Yes, B01.11 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to B01.11? +
ICD-10 B01.11 includes: Postchickenpox encephalitis and encephalomyelitis.
Is B01.11 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with B01.11? +
Procedures frequently paired with B01.11 include: 95708, 95721, 95719, 95813, 95822.
What ICD-9 codes does B01.11 map to? +
Per CMS GEMs, B01.11 maps to ICD-9 codes: 0520. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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