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B44.2 ICD-10-CM Code: Tonsillar aspergillosis

B44.2 maps to CMS-HCC V28 6 (RAF 0.381). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Mycoses (B35-B49)

B44.2

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

Tonsillar aspergillosis

A fungal infection of the tonsils caused by Aspergillus mold, which can cause inflammation and infection in the throat area.

Buddy the Bee presenting code insight

Buddy Insight

Tonsillar aspergillosis is an uncommon form of Aspergillus infection localized to the tonsillar tissue, typically occurring in immunocompromised patients.

CMS-HCC V28

HCC 6

RAF 0.381

CMS-HCC V24

HCC 6

RAF 0.424

ACA/HHS

HCC 6

Varies by metal level

ESRD/PACE

HCC 6

RAF 0.076

RXHCC

HCC 5

RAF 0.468

Code Book Path

Official
B44Aspergillosis
B44.2Tonsillar aspergillosis

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for B44.2 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for B44.2 in this effective period.

Related Child Codes

Official
B44.0Invasive pulmonary aspergillosis
B44.1Other pulmonary aspergillosis
B44.7Disseminated aspergillosis
B44.8Other forms of aspergillosis
B44.9Aspergillosis, unspecified

Includes

Official
  • aspergilloma

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for B44.2 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for B44.2 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for B44.2 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for B44.2 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Biopsy or culture confirmation of Aspergillus from tonsillar tissue
Documented immunocompromised state (neutropenia, transplant, HIV)
Physical exam findings: tonsillar enlargement, necrotic tissue, pseudomembrane
Symptoms documented: sore throat, dysphagia, odynophagia

MEAT Support

HCC Buddy guidance
Biopsy or culture confirmation of Aspergillus from tonsillar tissue
Documented immunocompromised state (neutropenia, transplant, HIV)
Physical exam findings: tonsillar enlargement, necrotic tissue, pseudomembrane
Symptoms documented: sore throat, dysphagia, odynophagia

Audit Caution

HCC Buddy guidance
Coding as bacterial tonsillitis when culture or biopsy confirms fungal etiology — always check microbiology results
Using this code when tonsillar involvement is part of disseminated aspergillosis (B44.7 is more appropriate)
Missing the underlying immunocompromise that should be coded alongside this opportunistic infection

Common Mistakes

HCC Buddy guidance
B44.0 (Invasive pulmonary aspergillosis) - lung involvement, not tonsillar
B44.7 (Disseminated aspergillosis) - use if Aspergillus has spread to multiple organ systems including tonsils
J03.90 (Acute tonsillitis, unspecified) - bacterial tonsillitis; fungal etiology requires the B44.2 code

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 B44.2 an HCC code?

Yes. B44.2 (Tonsillar aspergillosis) maps to Opportunistic Infections under the CMS-HCC V28 risk adjustment model (and Opportunistic Infections under V24), with a community non-dual aged RAF of 0.381. It is billable for payment year 2026.

Coder answer: B44.2 is billable and maps to V28 HCC 6, Opportunistic Infections. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
B44.2
Description
Tonsillar aspergillosis
HCC (V28)
HCC 6 — Opportunistic Infections
RAF
0.381
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 6, Opportunistic Infections
0.381
V24HCC 6, Opportunistic Infections
0.424
ESRDHCC 6, Opportunistic Infections
0.076
RxHCCHCC 5, Opportunistic Infections
0.468

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work B44.2 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for B44.2

For B44.2 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 B44.2 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

B44.2 is the ICD-10-CM diagnosis code for tonsillar aspergillosis. A fungal infection of the tonsils caused by Aspergillus mold, which can cause inflammation and infection in the throat area. B44.2 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering mycoses (b35-b49).

Under the CMS-HCC V28 risk adjustment model, B44.2 maps to Opportunistic Infections (HCC 6) with a community, non-dual, aged base RAF weight of 0.381. Under the older V24 model, B44.2 mapped to the same category but with a base RAF weight of 0.424, V28 recalibrated weights across the entire model. 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.

Confirm the infection is specifically in the tonsillar tissue and not a secondary manifestation of pulmonary aspergillosis. Because B44.2 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 B44.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Confirm the infection is specifically in the tonsillar tissue and not a secondary manifestation of pulmonary aspergillosis
  • •Document whether the patient has immunocompromise, as this affects treatment and prognosis

Clinical Significance

Tonsillar aspergillosis is an uncommon form of Aspergillus infection localized to the tonsillar tissue, typically occurring in immunocompromised patients. As an opportunistic fungal infection, it signals significant immune dysfunction and carries the same high RAF weight as other aspergillosis codes, making it important for risk adjustment capture.

Documentation Requirements

  • ✓Biopsy or culture confirmation of Aspergillus from tonsillar tissue
  • ✓Documented immunocompromised state (neutropenia, transplant, HIV)
  • ✓Physical exam findings: tonsillar enlargement, necrotic tissue, pseudomembrane
  • ✓Symptoms documented: sore throat, dysphagia, odynophagia
  • ✓Evidence that infection is localized to tonsils versus disseminated disease

Commonly Confused Codes

  • •B44.0 (Invasive pulmonary aspergillosis) - lung involvement, not tonsillar
  • •B44.7 (Disseminated aspergillosis) - use if Aspergillus has spread to multiple organ systems including tonsils
  • •J03.90 (Acute tonsillitis, unspecified) - bacterial tonsillitis; fungal etiology requires the B44.2 code

Child Codes

B44.0Invasive pulmonary aspergillosis
HCC 6
B44.1Other pulmonary aspergillosis
HCC 6
B44.2Tonsillar aspergillosis
HCC 6
B44.7Disseminated aspergillosis
HCC 6
B44.8Other forms of aspergillosis
B44.9Aspergillosis, unspecified
HCC 6

Code Hierarchy

└B44Aspergillosis└B44.2Tonsillar aspergillosis
└B44.2Tonsillar aspergillosis

Because B44.2 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

B44.2 maps to CMS-HCC V28 category 6, Opportunistic Infections. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because B44.2 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

Work B44.2 in HCC Buddy

Open B44.2 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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