A96.1 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupA96.1

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Arthropod-borne viral fevers and viral hemorrhagic fevers (A90-A99)

A96.1

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Machupo hemorrhagic fever

Machupo hemorrhagic fever is a rare, severe viral infection transmitted by infected rodents that causes bleeding, high fever, and potentially life-threatening complications. It is endemic to Bolivia and is characterized by sudden onset of fever, muscle pain, and hemorrhagic manifestations.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

A96Arenaviral hemorrhagic fever A96.1Machupo hemorrhagic fever

Inclusion Terms

Official

Bolivian hemorrhagic fever

Excludes 2

Official

carrier or suspected carrier of infectious disease (Z22.-)Inherited from A00-B99
infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium (O98.-)Inherited from A00-B99
infectious and parasitic diseases specific to the perinatal period (P35-P39)Inherited from A00-B99
influenza and other acute respiratory infections (J00-J22)Inherited from A00-B99

Related Codes

Official

A96.0Junin hemorrhagic fever A96.2Lassa fever A96.8Other arenaviral hemorrhagic fevers A96.9Arenaviral hemorrhagic fever, unspecified

Includes

Official

diseases generally recognized as communicable or transmissibleInherited from A00-B99

Excludes 1

Official

certain localized infections - see body system-related chaptersInherited from A00-B99

Code First

Official

No Code First sequencing instructions are included in this display for A96.1. Check the code and parent instructions in the Code Book.

Use Additional

Official

code to identify resistance to antimicrobial drugs (Z16.-)Inherited from A00-B99

Code Also

Official

No Code Also instructions are included in this display for A96.1. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

This is a reportable disease in most jurisdictions; verify local public health reporting requirements when assigning this code

Machupo fever is an Arenavirus infection; ensure documentation clearly identifies this specific hemorrhagic fever rather than other viral hemorrhagic fevers (Ebola, Marburg, Lassa, etc.) which have different codes

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is A96.1 an HCC code?

No. A96.1 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: A96.1
Description: Machupo hemorrhagic fever
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

A96.1 is the ICD-10-CM diagnosis code for machupo hemorrhagic fever. Machupo hemorrhagic fever is a rare, severe viral infection transmitted by infected rodents that causes bleeding, high fever, and potentially life-threatening complications. It is endemic to Bolivia and is characterized by sudden onset of fever, muscle pain, and hemorrhagic manifestations. A96.1 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).

A96.1 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

This is a reportable disease in most jurisdictions; verify local public health reporting requirements when assigning this code.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for A96.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is a reportable disease in most jurisdictions; verify local public health reporting requirements when assigning this code
•Machupo fever is an Arenavirus infection; ensure documentation clearly identifies this specific hemorrhagic fever rather than other viral hemorrhagic fevers (Ebola, Marburg, Lassa, etc.) which have different codes