Question 1

What is ICD-10 code B86?

Accepted Answer

B86 is the ICD-10-CM diagnosis code for scabies. A contagious skin infection caused by the scabies mite, characterized by intense itching, burrows in the skin, and a rash that typically worsens at night. B86 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).

B86 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

Document the extent of infestation (localized vs. generalized) and whether it is crusted scabies for treatment planning.

Question 2

Is B86 an HCC code?

Accepted Answer

No. B86 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is B86 billable?

Accepted Answer

Yes. B86 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. B86 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for B86?

Accepted Answer

B86 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards B86 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 5

What should coders know when reporting B86?

Accepted Answer

Document the extent of infestation (localized vs. generalized) and whether it is crusted scabies for treatment planning Note that scabies is highly contagious; consider documenting exposure history and need for contact tracing

HCC Buddy Code Card

B86

Is B86 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Code Hierarchy

Work B86 in HCC Buddy

B86 ICD-10-CM Code: Scabies

HCC Buddy Code Card

B86

Is B86 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Code Hierarchy

Work B86 in HCC Buddy