ICD-10 J12
Non-Billable HeaderViral pneumonia, not elsewhere classified
About ICD-10-CM J12
ICD-10-CM code J12 represents Viral pneumonia, not elsewhere classified. This is a non-billable header code in the Respiratory System chapter (block J12). The 2026 edition of ICD-10-CM J12 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 2 Excludes
Not included here, the excluded code is not part of J12, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- aspiration pneumonia due to anesthesia during labor and delivery (O74.0)
- aspiration pneumonia due to anesthesia during pregnancy (O29)
- aspiration pneumonia due to anesthesia during puerperium (O89.0)
- aspiration pneumonia due to solids and liquids (J69.-)
- aspiration pneumonia NOS (J69.0)
- congenital pneumonia (P23.0)
- congenital rubella pneumonitis (P35.0)
- interstitial pneumonia NOS (J84.9)
- lipid pneumonia (J69.1)
- neonatal aspiration pneumonia (P24.-)
Includes
- bronchopneumonia due to viruses other than influenza viruses
Coding Notes
Code Also
- associated abscess, if applicable (J85.1)
Code First
- associated influenza, if applicable (J09.X1, J10.0-, J11.0-)
Medicare LCD Coverage for J12
Local Coverage Determinations (LCDs) from CMS MACs that list J12 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 J12.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but J12 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with J12
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 J12
Other codes in section J09-J18 (Influenza and pneumonia).
ICD-10 J12, Billing FAQ
Is ICD-10 code J12 billable? +
No, J12 is a non-billable header code. Use a more specific child code from block J12 when submitting claims.
What codes are Type 2 Excludes for J12? +
Type 2 Excludes (may be coded together when both conditions exist): aspiration pneumonia due to anesthesia during labor and delivery (O74.0); aspiration pneumonia due to anesthesia during pregnancy (O29); aspiration pneumonia due to anesthesia during puerperium (O89.0)
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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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