B45.7
BillableDisseminated cryptococcosis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is B45.7 an HCC code?
Yes. B45.7 maps to Opportunistic Infections under the CMS-HCC V28 risk adjustment model (and Opportunistic Infections under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for B45.7
For B45.7 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 B45.7 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
B45.7 is the ICD-10-CM diagnosis code for disseminated cryptococcosis. Disseminated cryptococcosis is a serious fungal infection caused by Cryptococcus that has spread throughout the body, commonly affecting the lungs, brain, and bloodstream. This condition typically occurs in people with weakened immune systems, such as those with HIV/AIDS or undergoing immunosuppressive therapy. B45.7 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, B45.7 maps to Opportunistic Infections (HCC 6) with a community, non-dual, aged base RAF weight of 0.439. Under the older V24 model, B45.7 mapped to the same category but with a base RAF weight of 0.440 — 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.
Always verify the extent of dissemination and document which body systems are affected, as this may require additional codes for specific site involvement (e.g., meningitis, pneumonia). Because B45.7 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 B45.7 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always verify the extent of dissemination and document which body systems are affected, as this may require additional codes for specific site involvement (e.g., meningitis, pneumonia)
- •Ensure the underlying immunocompromised condition is also coded separately, as cryptococcosis is an opportunistic infection that requires documentation of the primary immune disorder
Clinical Significance
Disseminated cryptococcosis indicates Cryptococcus infection spread through the bloodstream to multiple organ systems, representing one of the most serious opportunistic infections with high mortality. It is a hallmark of advanced immunosuppression, particularly AIDS, and demands aggressive combination antifungal therapy and management of the underlying immunodeficiency.
Documentation Requirements
- ✓Positive cryptococcal antigen or cultures from two or more body sites
- ✓Documentation of specific organ systems involved (lung, brain, skin, blood, bone)
- ✓Fungemia documented if blood cultures are positive
- ✓CD4 count or other marker of immunosuppression severity
- ✓Complete treatment plan including induction, consolidation, and maintenance therapy phases