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ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 R06.5

Billable / Specific

Mouth breathing

R06
Block
0
Synonyms
21
LCDs
1
Payer Policies
2
Linked CPTs

About ICD-10-CM R06.5

ICD-10-CM code R06.5 represents Mouth breathing. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R06). The 2026 edition of ICD-10-CM R06.5 became effective on October 1, 2025.

Type 2 Excludes

Not included here, the excluded code is not part of R06.5, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.

  • dry mouth NOS (R68.2)

Medicare LCD Coverage for R06.5

Local Coverage Determinations (LCDs) from CMS MACs that list R06.5 as a covered diagnosis.

21 LCDs

Showing top 10 of 21 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43246 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43243 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43235 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43250 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43236 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43247 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43249 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43254 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43245 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43244 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing R06.5.

1 policies

1 Medicare

Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Policy ID: ART-57063

CPT Codes Commonly Billed with R06.5

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

2 linkages
  • 42820 Tonsillectomy — chronic tonsillitis, hypertrophic tonsils, sleep apnea, peritonsillar abscess, acute tonsillitis, mouth breathing, dysphagia ENT
  • 30520 Septoplasty — deviated septum, mouth breathing, nasal obstruction, sleep apnea ENT

Convert R06.5 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
R06.5 78499 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 R06.5, Billing FAQ

Is ICD-10 code R06.5 billable? +

Yes, R06.5 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What codes are Type 2 Excludes for R06.5? +

Type 2 Excludes (may be coded together when both conditions exist): dry mouth NOS (R68.2)

What CPT codes are commonly billed with R06.5? +

Procedures frequently paired with R06.5 include: 42820, 30520.

What ICD-9 codes does R06.5 map to? +

Per CMS GEMs, R06.5 maps to ICD-9 codes: 78499. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on July 16, 2026.

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