ICD-10 B25.0
Billable / Specific HCC v28: 6 MCCCytomegaloviral pneumonitis
About ICD-10-CM B25.0
ICD-10-CM code B25.0 represents Cytomegaloviral pneumonitis. This is a billable/specific code in the Infectious and Parasitic Diseases chapter (block B25). The 2026 edition of ICD-10-CM B25.0 became effective on October 1, 2025.
Coding Tips for B25.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
B25.0 is a CMS-HCC v28 risk-adjustment code (category 6). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
B25.0 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.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, MCC
codes Cytomegaloviral pneumonitis. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for B25.0
Local Coverage Determinations (LCDs) from CMS MACs that list B25.0 as a covered diagnosis.
Showing top 10 of 688 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing B25.0.
2 Aetna
1 Cigna
5 Medicare
CPT Codes Commonly Billed with B25.0
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 94726 CMS LCD: Billing and Coding: Respiratory Therapy (Respiratory Care) CMS LCD
- 94004 CMS LCD: Billing and Coding: Respiratory Therapy (Respiratory Care) CMS LCD
- 94621 CMS LCD: Billing and Coding: Respiratory Therapy (Respiratory Care) CMS LCD
- 94011 CMS LCD: Billing and Coding: Respiratory Therapy (Respiratory Care) CMS LCD
- 94003 CMS LCD: Billing and Coding: Respiratory Therapy (Respiratory Care) CMS LCD
- 94668 CMS LCD: Billing and Coding: Respiratory Therapy (Respiratory Care) CMS LCD
- 94070 CMS LCD: Billing and Coding: Respiratory Therapy (Respiratory Care) CMS LCD
- 94664 CMS LCD: Billing and Coding: Respiratory Therapy (Respiratory Care) CMS LCD
- 94012 CMS LCD: Billing and Coding: Respiratory Therapy (Respiratory Care) CMS LCD
- 31502 CMS LCD: Billing and Coding: Respiratory Therapy (Respiratory Care) CMS LCD
Convert B25.0 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 |
|---|---|---|
| B25.0 | 0785 | 10111 |
| B25.0 | 4841 | 10112 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To B25.0
Other codes in section B25-B34 (Other viral diseases).
ICD-10 B25.0, Billing FAQ
Is ICD-10 code B25.0 billable? +
Yes, B25.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does B25.0 affect Medicare Advantage HCC risk adjustment? +
Yes. B25.0 maps to CMS-HCC v28 category 6. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is B25.0 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 B25.0? +
Procedures frequently paired with B25.0 include: 94726, 94004, 94621, 94011, 94003.
What ICD-9 codes does B25.0 map to? +
Per CMS GEMs, B25.0 maps to ICD-9 codes: 0785, 4841. 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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