B96.4 ICD-10-CM Code: Proteus (mirabilis) (morganii) as the cause of diseases classified elsewhere
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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Bacterial and viral infectious agents (B95-B97)
B96.4
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceProteus (mirabilis) (morganii) as the cause of diseases classified elsewhere
An infection caused by Proteus bacteria (mirabilis or morganii), which commonly affects the urinary tract and can cause wound infections.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for B96.4 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for B96.4 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for B96.4 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for B96.4 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for B96.4 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for B96.4 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for B96.4 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is B96.4 an HCC code?
No. B96.4 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
B96.4 is the ICD-10-CM diagnosis code for proteus (mirabilis) (morganii) as the cause of diseases classified elsewhere. An infection caused by Proteus bacteria (mirabilis or morganii), which commonly affects the urinary tract and can cause wound infections. B96.4 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).
B96.4 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.
Proteus mirabilis is the most common species and is frequently associated with catheter-related urinary tract infections.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for B96.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Proteus mirabilis is the most common species and is frequently associated with catheter-related urinary tract infections
- •These organisms are known for producing urease, which can lead to alkaline urine and stone formation