B48.4 ICD-10-CM Code: Penicillosis
B48.4 maps to CMS-HCC V28 6. A source-labeled RAF reference is available. 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)
B48.4
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePenicillosis
A fungal infection caused by Penicillium fungus that primarily affects the lungs and can disseminate to other organs, especially in patients with compromised immune systems.
Buddy Insight
Penicillosis (talaromycosis) caused by Talaromyces marneffei (formerly Penicillium marneffei) is an AIDS-defining illness endemic to Southeast Asia and southern China.
CMS-HCC V28
MappedHCC 6
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 006
Code-level coefficient reference
ESRD/PACE
MappedHCC 6
Code-level coefficient reference
RXHCC
MappedHCC 5
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Talaromycosis
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for B48.4 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for B48.4 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for B48.4 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for B48.4 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for B48.4 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for B48.4 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 B48.4 an HCC code?
Yes. B48.4 (Penicillosis) maps to HCC 6, Opportunistic Infections under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.381. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: B48.4 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
- B48.4
- Description
- Penicillosis
- HCC (V28)
- HCC 6 — Opportunistic Infections
- RAF reference coefficient
- 0.381
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work B48.4 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for B48.4
For B48.4 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 B48.4 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
B48.4 is the ICD-10-CM diagnosis code for penicillosis. A fungal infection caused by Penicillium fungus that primarily affects the lungs and can disseminate to other organs, especially in patients with compromised immune systems. B48.4 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, B48.4 maps to Opportunistic Infections (HCC 6) with a source-labeled community, non-dual, aged reference coefficient of 0.381. No V24 mapping is shown for B48.4; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Document whether infection is localized or disseminated. Because B48.4 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for B48.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether infection is localized or disseminated
- •Verify patient's HIV status or other immunocompromising conditions as this is an opportunistic infection
Clinical Significance
Penicillosis (talaromycosis) caused by Talaromyces marneffei (formerly Penicillium marneffei) is an AIDS-defining illness endemic to Southeast Asia and southern China. It is the third most common opportunistic infection in HIV patients in this region after tuberculosis and cryptococcosis. Disseminated disease manifests with distinctive umbilicated papular skin lesions resembling molluscum contagiosum.
Documentation Requirements
- ✓Culture confirmation of Talaromyces marneffei from blood, skin, or tissue specimens
- ✓CD4 count documented (typically <100 cells/microL)
- ✓Characteristic skin lesions described: umbilicated papules on face, trunk, and extremities
- ✓Travel or residence history in Southeast Asia documented
- ✓Treatment regimen documented (amphotericin B induction followed by itraconazole)
Commonly Confused Codes
- •B45.2 (Cutaneous cryptococcosis) - both cause papular skin lesions in HIV patients; culture differentiates
- •B08.1 (Molluscum contagiosum) - penicillosis skin lesions mimic molluscum; always biopsy in HIV patients with low CD4
- •B48.8 (Other specified mycoses) - penicillosis has its own specific code; do not use B48.8