B95.2 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupB95.2

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Bacterial and viral infectious agents (B95-B97)

B95.2

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

Enterococcus as the cause of diseases classified elsewhere

Enterococcus bacteria identified as the cause of another disease or infection in the patient.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

B95Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere B95.2Enterococcus as the cause of diseases classified elsewhere

Inclusion Terms

Official

No inclusion terms are included in this display for B95.2. Check the code and parent instructions in the Code Book.

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

Official

B95.0Streptococcus, group A, as the cause of diseases classified elsewhere B95.1Streptococcus, group B, as the cause of diseases classified elsewhere B95.3Streptococcus pneumoniae as the cause of diseases classified elsewhere B95.4Other streptococcus as the cause of diseases classified elsewhere B95.5Unspecified streptococcus as the cause of diseases classified elsewhere

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

Official

No Code First sequencing instructions are included in this display for B95.2. 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

Official

No Code Also instructions are included in this display for B95.2. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Use as a secondary code paired with the primary diagnosis code for the infection caused

Enterococcus commonly causes urinary tract infections and wound infections

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 B95.2 an HCC code?

No. B95.2 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: B95.2
Description: Enterococcus as the cause of diseases classified elsewhere
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

B95.2 is the ICD-10-CM diagnosis code for enterococcus as the cause of diseases classified elsewhere. Enterococcus bacteria identified as the cause of another disease or infection in the patient. B95.2 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering bacterial and viral infectious agents (b95-b97).

B95.2 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.

Use as a secondary code paired with the primary diagnosis code for the infection caused.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for B95.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use as a secondary code paired with the primary diagnosis code for the infection caused
•Enterococcus commonly causes urinary tract infections and wound infections