ICD-10 K12
Non-Billable HeaderStomatitis and related lesions
About ICD-10-CM K12
ICD-10-CM code K12 represents Stomatitis and related lesions. This is a non-billable header code in the Digestive System chapter (block K12). The 2026 edition of ICD-10-CM K12 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 K12. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- cancrum oris (A69.0)
- cheilitis (K13.0)
- gangrenous stomatitis (A69.0)
- herpesviral [herpes simplex] gingivostomatitis (B00.2)
- noma (A69.0)
Use Additional Code
When coding K12, also report these additional codes when applicable.
- code to identify:
- alcohol abuse and dependence (F10.-)
- exposure to environmental tobacco smoke (Z77.22)
- exposure to tobacco smoke in the perinatal period (P96.81)
- history of tobacco dependence (Z87.891)
- occupational exposure to environmental tobacco smoke (Z57.31)
- tobacco dependence (F17.-)
- tobacco use (Z72.0)
Medicare LCD Coverage for K12
Local Coverage Determinations (LCDs) from CMS MACs that list K12 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 K12.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but K12 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with K12
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 K12
Other codes in section K00-K14 (Diseases of oral cavity and salivary glands).
ICD-10 K12, Billing FAQ
Is ICD-10 code K12 billable? +
No, K12 is a non-billable header code. Use a more specific child code from block K12 when submitting claims.
What codes are Type 1 Excludes for K12? +
Type 1 Excludes (never code together with K12): cancrum oris (A69.0); cheilitis (K13.0); gangrenous stomatitis (A69.0)
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.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
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 June 1, 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