ICD-10 P23
Non-Billable HeaderCongenital pneumonia
About ICD-10-CM P23
ICD-10-CM code P23 represents Congenital pneumonia. This is a non-billable header code in the Perinatal Period chapter (block P23). The 2026 edition of ICD-10-CM P23 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 P23. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- neonatal pneumonia resulting from aspiration (P24.-)
Includes
- infective pneumonia acquired in utero or during birth
Medicare LCD Coverage for P23
Local Coverage Determinations (LCDs) from CMS MACs that list P23 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 P23.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but P23 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with P23
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 P23
Other codes in section P19-P29 (Respiratory and cardiovascular disorders specific to the perinatal period).
ICD-10 P23, Billing FAQ
Is ICD-10 code P23 billable? +
No, P23 is a non-billable header code. Use a more specific child code from block P23 when submitting claims.
What codes are Type 1 Excludes for P23? +
Type 1 Excludes (never code together with P23): neonatal pneumonia resulting from aspiration (P24.-)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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