ICD-10 J03.8
Non-Billable HeaderAcute tonsillitis due to other specified organisms
About ICD-10-CM J03.8
ICD-10-CM code J03.8 represents Acute tonsillitis due to other specified organisms. This is a non-billable header code in the Respiratory System chapter (block J03). The 2026 edition of ICD-10-CM J03.8 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Type 1 Excludes
Pure excludes, these codes can never be coded together with J03.8. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- diphtheritic tonsillitis (A36.0)
- herpesviral pharyngotonsillitis (B00.2)
- streptococcal tonsillitis (J03.0)
- tuberculous tonsillitis (A15.8)
- Vincent's tonsillitis (A69.1)
Use Additional Code
When coding J03.8, also report these additional codes when applicable.
- code (B95-B97) to identify infectious agent.
Medicare LCD Coverage for J03.8
Local Coverage Determinations (LCDs) from CMS MACs that list J03.8 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J03.8.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but J03.8 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with J03.8
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
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.
Codes Adjacent To J03.8
Other codes in section J00-J06 (Acute upper respiratory infections).
ICD-10 J03.8, Billing FAQ
Is ICD-10 code J03.8 billable? +
No, J03.8 is a non-billable header code. Use a more specific child code from block J03 when submitting claims.
What codes are Type 1 Excludes for J03.8? +
Type 1 Excludes (never code together with J03.8): diphtheritic tonsillitis (A36.0); herpesviral pharyngotonsillitis (B00.2); streptococcal tonsillitis (J03.0)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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