B85.0 ICD-10-CM Code: Pediculosis due to Pediculus humanus capitis
B85.0 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Pediculosis, acariasis and other infestations (B85-B89)
B85.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePediculosis due to Pediculus humanus capitis
A lice infestation of the scalp and hair caused by the human head louse, commonly seen in children and characterized by itching and visible nits.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Head-louse infestation
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
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
OfficialNo Code First sequencing instructions are included in this display for B85.0. 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
OfficialNo Code Also instructions are included in this display for B85.0. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
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 B85.0 an HCC code?
No. B85.0 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
- B85.0
- Description
- Pediculosis due to Pediculus humanus capitis
- 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
B85.0 is the ICD-10-CM diagnosis code for pediculosis due to pediculus humanus capitis. A lice infestation of the scalp and hair caused by the human head louse, commonly seen in children and characterized by itching and visible nits. B85.0 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering pediculosis, acariasis and other infestations (b85-b89).
B85.0 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.
Document the anatomical location (scalp/hair) to distinguish from body lice (B85.1).
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for B85.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the anatomical location (scalp/hair) to distinguish from body lice (B85.1)
- •Verify treatment documentation as this condition typically requires topical pediculicides and may require follow-up coding for treatment encounters