A40.8
BillableOther streptococcal sepsis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is A40.8 an HCC code?
Yes. A40.8 maps to Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock under the CMS-HCC V28 risk adjustment model (and Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for A40.8
For A40.8 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed A40.8 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
A40.8 is the ICD-10-CM diagnosis code for other streptococcal sepsis. This code describes a serious bloodstream infection caused by streptococcal bacteria that doesn't fit into the more specific streptococcal sepsis categories. Sepsis is a life-threatening condition where the body's response to infection causes tissue damage and organ dysfunction. A40.8 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering other bacterial diseases (a30-a49).
Under the CMS-HCC V28 risk adjustment model, A40.8 maps to Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock (HCC 2) with a community, non-dual, aged base RAF weight of 0.455. The V24 model used during the PY2024–PY2025 transition mapped A40.8 the same way and at the same RAF weight. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Use this code only when the streptococcal sepsis is not caused by Group A, Group B, Group D, or pneumococcal streptococci, as those have more specific codes (A40.0-A40.3). Because A40.8 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for A40.8 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the streptococcal sepsis is not caused by Group A, Group B, Group D, or pneumococcal streptococci, as those have more specific codes (A40.0-A40.3)
- •Always code sepsis with the underlying infection source when documented, and ensure the principal diagnosis is clearly identified as sepsis rather than just the infection
Clinical Significance
Other streptococcal sepsis captures bloodstream infections caused by streptococcal species other than Group A, Group B, and Streptococcus pneumoniae — including Streptococcus anginosus group (milleri), Streptococcus mitis, and other viridans group streptococci. These organisms are frequently associated with deep-seated abscesses, endocarditis, and intra-abdominal infections.
Documentation Requirements
- ✓Blood cultures identifying the specific streptococcal species (not Group A, B, or pneumoniae)
- ✓Documentation of sepsis criteria with identified streptococcal source
- ✓Source of infection (dental/oral source, intra-abdominal abscess, endocarditis)
- ✓Severity assessment and organ dysfunction documentation
- ✓Species-level identification from microbiology to confirm appropriate code selection
Commonly Confused Codes
- •A40.0 (Group A streptococcal sepsis), A40.1 (Group B), A40.3 (S. pneumoniae) — Use those specific codes when those organisms are identified; A40.8 is for all other streptococcal species
- •A40.9 (Streptococcal sepsis, unspecified) — Use A40.8 when the streptococcal species is known but falls outside groups A/B/pneumoniae
- •A41.89 (Other specified sepsis) — A40.8 is correct for streptococcal species; A41.89 is for non-streptococcal, non-staphylococcal organisms