ICD-10 Z16
Non-Billable HeaderResistance to antimicrobial drugs
About ICD-10-CM Z16
ICD-10-CM code Z16 represents Resistance to antimicrobial drugs. This is a non-billable header code in the Factors Influencing Health Status chapter (block Z16). The 2026 edition of ICD-10-CM Z16 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 Z16. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- Methicillin resistant Staphylococcus aureus infection (A49.02)
- Methicillin resistant Staphylococcus aureus pneumonia (J15.212)
- Sepsis due to Methicillin resistant Staphylococcus aureus (A41.02)
Coding Notes
Code First
- the infection
Medicare LCD Coverage for Z16
Local Coverage Determinations (LCDs) from CMS MACs that list Z16 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 Z16.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but Z16 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with Z16
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 Z16
Other codes in section Z16 (Resistance to antimicrobial drugs).
ICD-10 Z16, Billing FAQ
Is ICD-10 code Z16 billable? +
No, Z16 is a non-billable header code. Use a more specific child code from block Z16 when submitting claims.
What codes are Type 1 Excludes for Z16? +
Type 1 Excludes (never code together with Z16): Methicillin resistant Staphylococcus aureus infection (A49.02); Methicillin resistant Staphylococcus aureus pneumonia (J15.212); Sepsis due to Methicillin resistant Staphylococcus aureus (A41.02)
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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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