A42.81 ICD-10-CM Code: Actinomycotic meningitis
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Other bacterial diseases (A30-A49)
A42.81
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceActinomycotic meningitis
This is a serious brain infection caused by actinomyces bacteria, which affects the protective membranes surrounding the brain and spinal cord. It's a rare type of meningitis that requires specific antibiotic treatment.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
MappedHCC 3
Varies by metal level
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for A42.81 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for A42.81 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for A42.81 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for A42.81 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for A42.81 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for A42.81 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for A42.81 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is A42.81 an HCC code?
No. A42.81 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
A42.81 is the ICD-10-CM diagnosis code for actinomycotic meningitis. This is a serious brain infection caused by actinomyces bacteria, which affects the protective membranes surrounding the brain and spinal cord. It's a rare type of meningitis that requires specific antibiotic treatment. A42.81 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering other bacterial diseases (a30-a49).
A42.81 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Verify that the meningitis is confirmed to be caused by actinomyces species before coding A42.81; documentation should clearly indicate actinomycotic infection rather than other bacterial causes.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for A42.81 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that the meningitis is confirmed to be caused by actinomyces species before coding A42.81; documentation should clearly indicate actinomycotic infection rather than other bacterial causes
- •This code is part of the actinomycosis category (A42); ensure you are not confusing this with other meningitis codes (G00-G03 series) and that the actinomycotic etiology is explicitly documented