ICD-10 O91
Non-Billable HeaderInfections of breast associated with pregnancy, the puerperium and lactation
About ICD-10-CM O91
ICD-10-CM code O91 represents Infections of breast associated with pregnancy, the puerperium and lactation. This is a non-billable header code in the Pregnancy, Childbirth, and Puerperium chapter (block O91). The 2026 edition of ICD-10-CM O91 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.
Coding Tips for O91
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Most O codes require a 7th character indicating trimester (1 = first, 2 = second, 3 = third). Some require fetus identification character. Code O09 (supervision of high-risk pregnancy) is required as a secondary code when applicable.
Use Additional Code
When coding O91, also report these additional codes when applicable.
- code to identify infection
Medicare LCD Coverage for O91
Local Coverage Determinations (LCDs) from CMS MACs that list O91 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 O91.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but O91 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with O91
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 O91
Other codes in section O85-O92 (Complications predominantly related to the puerperium).
ICD-10 O91, Billing FAQ
Is ICD-10 code O91 billable? +
No, O91 is a non-billable header code. Use a more specific child code from block O91 when submitting claims.
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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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