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

ICD-10 J02.9

Billable / Specific

Acute pharyngitis, unspecified

J02
Block
6
Synonyms
37
LCDs
5
Payer Policies
4
Linked CPTs

About ICD-10-CM J02.9

ICD-10-CM code J02.9 represents Acute pharyngitis, unspecified. This is a billable/specific code in the Respiratory System chapter (block J02). The 2026 edition of ICD-10-CM J02.9 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under J02.9. Per CMS ICD-10-CM Tabular 2026.

  • Gangrenous pharyngitis (acute)
  • Infective pharyngitis (acute) NOS
  • Pharyngitis (acute) NOS
  • Sore throat (acute) NOS
  • Suppurative pharyngitis (acute)
  • Ulcerative pharyngitis (acute)

Type 1 Excludes

Pure excludes, these codes can never be coded together with J02.9. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • influenza virus with other respiratory manifestations (J09.X2, J10.1, J11.1)

Medicare LCD Coverage for J02.9

Local Coverage Determinations (LCDs) from CMS MACs that list J02.9 as a covered diagnosis.

37 LCDs

Showing top 10 of 37 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Respiratory Pathogen Panel Testing
Article ID: 58577, Effective: 2026-01-01 00:00:00, 193 covered, 0 non-covered
CPT 0202U →
CMS LCD: Billing and Coding: Respiratory Pathogen Panel Testing
Article ID: 58577, Effective: 2026-01-01 00:00:00, 193 covered, 0 non-covered
CPT 0225U →
CMS LCD: Billing and Coding: Respiratory Pathogen Panel Testing
Article ID: 58577, Effective: 2026-01-01 00:00:00, 193 covered, 0 non-covered
CPT 0223U →
CMS LCD: Billing and Coding: Respiratory Pathogen Panel Testing
Article ID: 58577, Effective: 2026-01-01 00:00:00, 193 covered, 0 non-covered
CPT 87913 →
CMS LCD: Billing and Coding: Respiratory Pathogen Panel Testing
Article ID: 58577, Effective: 2026-01-01 00:00:00, 193 covered, 0 non-covered
CPT 87812 →
CMS LCD: Billing and Coding: Respiratory Pathogen Panel Testing
Article ID: 58577, Effective: 2026-01-01 00:00:00, 193 covered, 0 non-covered
CPT 87633 →
CMS LCD: Billing and Coding: Respiratory Pathogen Panel Testing
Article ID: 58577, Effective: 2026-01-01 00:00:00, 193 covered, 0 non-covered
CPT 87428 →
CMS LCD: Billing and Coding: Respiratory Pathogen Panel Testing
Article ID: 58577, Effective: 2026-01-01 00:00:00, 193 covered, 0 non-covered
CPT 0115U →
CMS LCD: Billing and Coding: Respiratory Pathogen Panel Testing
Article ID: 58577, Effective: 2026-01-01 00:00:00, 193 covered, 0 non-covered
CPT 87637 →
CMS LCD: Billing and Coding: Respiratory Pathogen Panel Testing
Article ID: 58577, Effective: 2026-01-01 00:00:00, 193 covered, 0 non-covered
CPT 87631 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing J02.9.

5 policies

1 Cigna

Nucleic Acid Pathogen Testing - (0530)
Policy ID: MM_0530

3 Medicare

Billing and Coding: Respiratory Pathogen Panel Testing
Policy ID: ART-58575
Billing and Coding: Respiratory Pathogen Panel Testing
Policy ID: ART-58577
Billing and Coding: Respiratory Pathogen Panel Testing
Policy ID: ART-58741

1 Aetna

Esophageal and Airway pH Monitoring
Policy ID: CPB-0667

CPT Codes Commonly Billed with J02.9

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

4 linkages
  • 99202 New patient office visit — fever, headache, abdominal pain, cough, dyspnea, fatigue, dizziness, limb pain, nausea, routine exam, URI, UTI, pharyngitis, otitis, chest pain, weight loss Primary Care
  • 99212 Established patient — URI, UTI, pharyngitis, otitis, dermatitis, rash, viral infection, cellulitis, conjunctivitis, sinusitis, bronchitis, ankle sprain Primary Care
  • 99213 Established patient — HTN follow-up, diabetes management, hyperlipidemia, asthma, anxiety, common complaints, back pain, GERD, migraine, acne, joint pain, prediabetes, obesity, anemia, hypothyroid, fatigue Primary Care
  • 99282 ED visit level 2 — same as level 1 with low complexity MDM Emergency Medicine

Convert J02.9 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
J02.9 462 10000

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

ICD-10 J02.9, Billing FAQ

Is ICD-10 code J02.9 billable? +

Yes, J02.9 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 J02.9? +

ICD-10 J02.9 includes: Gangrenous pharyngitis (acute); Infective pharyngitis (acute) NOS; Pharyngitis (acute) NOS, and 3 more clinical synonyms.

What codes are Type 1 Excludes for J02.9? +

Type 1 Excludes (never code together with J02.9): influenza virus with other respiratory manifestations (J09.X2, J10.1, J11.1)

What CPT codes are commonly billed with J02.9? +

Procedures frequently paired with J02.9 include: 99202, 99212, 99213, 99282.

What ICD-9 codes does J02.9 map to? +

Per CMS GEMs, J02.9 maps to ICD-9 codes: 462. Useful for legacy data review and historical claim analysis.

Get the full PayerReady toolkit

Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.

Start free →

Run this code through our claim audit tool

Check NCCI bundling, MUE limits, and modifier logic before submission.

Try the auditor →

Did this page help?

Quick signal so we know what to improve.

Thanks!

If you want a code reference page that doesn't exist yet, email coding@payerready.com.

Sorry to hear that.

Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.

Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team

Faster Approvals

Ready to Cut Your Enrollment Timeline in Half?

Join providers in all 50 states who handed off credentialing to a dedicated specialist. Create your free account in minutes and start enrolling the same day.

All 50 States Covered
No Long-Term Contracts
HIPAA HIPAA Compliant Platform
Dedicated Specialist Included