A54.21
BillableGonococcal infection of kidney and ureter
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is A54.21 an HCC code?
No. A54.21 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
A54.21 is the ICD-10-CM diagnosis code for gonococcal infection of kidney and ureter. A bacterial infection caused by gonorrhea that has spread to the kidneys and ureters (the tubes that carry urine from the kidneys to the bladder). This is a serious complication of untreated gonorrhea that affects the upper urinary tract. A54.21 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering infections with a predominantly sexual mode of transmission (a50-a64).
A54.21 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 documentation specifies involvement of both kidney AND ureter, or code separately if only one site is affected (A54.20 for kidney alone, A54.22 for ureter alone).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for A54.21 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies involvement of both kidney AND ureter, or code separately if only one site is affected (A54.20 for kidney alone, A54.22 for ureter alone)
- •Ensure the provider documents this as a gonococcal infection; confirm the organism identification in the medical record before assigning this code