A92.5 ICD-10-CM Code: Zika virus disease
HCC Buddy Code Card
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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Arthropod-borne viral fevers and viral hemorrhagic fevers (A90-A99)
A92.5
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceZika virus disease
Zika virus disease is an infection caused by the Zika virus, typically transmitted by mosquitoes, that can cause fever, rash, joint pain, and other symptoms. In pregnant women, it can lead to serious complications affecting fetal development.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Zika virus fever
- Zika virus infection
- Zika NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for A92.5 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for A92.5 in this effective period.
Excludes 1
Official- congenital Zika virus disease (P35.4)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for A92.5 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for A92.5 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for A92.5 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 A92.5 an HCC code?
No. A92.5 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
A92.5 is the ICD-10-CM diagnosis code for zika virus disease. Zika virus disease is an infection caused by the Zika virus, typically transmitted by mosquitoes, that can cause fever, rash, joint pain, and other symptoms. In pregnant women, it can lead to serious complications affecting fetal development. A92.5 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering arthropod-borne viral fevers and viral hemorrhagic fevers (a90-a99).
A92.5 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.
Always check for documentation of pregnancy status when coding Zika virus disease, as this affects severity classification and may require additional codes for maternal or fetal complications.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for A92.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always check for documentation of pregnancy status when coding Zika virus disease, as this affects severity classification and may require additional codes for maternal or fetal complications
- •Verify whether the patient has confirmed Zika virus infection through testing versus suspected/probable infection, as confirmed cases use A92.5 while suspected cases may use a different code
Excludes 1, Do NOT code together
- congenital Zika virus disease (P35.4)