ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 B97.4

Billable / Specific

Respiratory syncytial virus as the cause of diseases classified elsewhere

B97
Block
1
Synonyms
25
LCDs
3
Payer Policies
0
Linked CPTs

About ICD-10-CM B97.4

ICD-10-CM code B97.4 represents Respiratory syncytial virus as the cause of diseases classified elsewhere. This is a billable/specific code in the Infectious and Parasitic Diseases chapter (block B97). The 2026 edition of ICD-10-CM B97.4 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under B97.4. Per CMS ICD-10-CM Tabular 2026.

  • RSV as the cause of diseases classified elsewhere

Type 1 Excludes

Pure excludes, these codes can never be coded together with B97.4. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • acute bronchiolitis due to respiratory syncytial virus (RSV) (J21.0)
  • acute bronchitis due to respiratory syncytial virus (RSV) (J20.5)
  • respiratory syncytial virus (RSV) pneumonia (J12.1)

Coding Notes

Code First

  • related disorders, such as:
  • otitis media (H65.-)
  • upper respiratory infection (J06.9)

Medicare LCD Coverage for B97.4

Local Coverage Determinations (LCDs) from CMS MACs that list B97.4 as a covered diagnosis.

25 LCDs

Showing top 10 of 25 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Article ID: 60187, Effective: , 301 covered, 0 non-covered
CPT J1561 →
CMS LCD: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Article ID: 60187, Effective: , 301 covered, 0 non-covered
CPT J1556 →
CMS LCD: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Article ID: 60187, Effective: , 301 covered, 0 non-covered
CPT J1566 →
CMS LCD: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Article ID: 60187, Effective: , 301 covered, 0 non-covered
CPT J1576 →
CMS LCD: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Article ID: 60187, Effective: , 301 covered, 0 non-covered
CPT J1554 →
CMS LCD: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Article ID: 60187, Effective: , 301 covered, 0 non-covered
CPT J1557 →
CMS LCD: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Article ID: 60187, Effective: , 301 covered, 0 non-covered
CPT J1568 →
CMS LCD: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Article ID: 60187, Effective: , 301 covered, 0 non-covered
CPT J1599 →
CMS LCD: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Article ID: 60187, Effective: , 301 covered, 0 non-covered
CPT J1459 →
CMS LCD: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Article ID: 60187, Effective: , 301 covered, 0 non-covered
CPT J1572 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing B97.4.

3 policies

2 Medicare

Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Policy ID: ART-59105
Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Policy ID: ART-60187

1 Aetna

Ribavirin (Virazole) Inhalation
Policy ID: CPB-0155

CPT Codes Commonly Billed with B97.4

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for B97.4

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert B97.4 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
B97.4 0796 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

Codes Adjacent To B97.4

Other codes in section B95-B97 (Bacterial and viral infectious agents).

B95 Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere (non-billable) B95.0 Streptococcus, group A, as the cause of diseases classified elsewhere B95.1 Streptococcus, group B, as the cause of diseases classified elsewhere B95.2 Enterococcus as the cause of diseases classified elsewhere B95.3 Streptococcus pneumoniae as the cause of diseases classified elsewhere B95.4 Other streptococcus as the cause of diseases classified elsewhere B95.5 Unspecified streptococcus as the cause of diseases classified elsewhere B95.6 Staphylococcus aureus as the cause of diseases classified elsewhere (non-billable) B95.61 Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere B95.62 Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere B95.7 Other staphylococcus as the cause of diseases classified elsewhere B95.8 Unspecified staphylococcus as the cause of diseases classified elsewhere B96 Other bacterial agents as the cause of diseases classified elsewhere (non-billable) B96.0 Mycoplasma pneumoniae [M. pneumoniae] as the cause of diseases classified elsewhere B96.1 Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases classified elsewhere B96.2 Escherichia coli [E. coli ] as the cause of diseases classified elsewhere (non-billable) B96.20 Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere B96.21 Shiga toxin-producing Escherichia coli [E. coli] [STEC] O157 as the cause of diseases classified elsewhere B96.22 Other specified Shiga toxin-producing Escherichia coli [E. coli] [STEC] as the cause of diseases classified elsewhere B96.23 Unspecified Shiga toxin-producing Escherichia coli [E. coli] [STEC] as the cause of diseases classified elsewhere

ICD-10 B97.4, Billing FAQ

Is ICD-10 code B97.4 billable? +

Yes, B97.4 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 B97.4? +

ICD-10 B97.4 includes: RSV as the cause of diseases classified elsewhere.

What codes are Type 1 Excludes for B97.4? +

Type 1 Excludes (never code together with B97.4): acute bronchiolitis due to respiratory syncytial virus (RSV) (J21.0); acute bronchitis due to respiratory syncytial virus (RSV) (J20.5); respiratory syncytial virus (RSV) pneumonia (J12.1)

What ICD-9 codes does B97.4 map to? +

Per CMS GEMs, B97.4 maps to ICD-9 codes: 0796. 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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