B97.31
BillableLentivirus as the cause of diseases classified elsewhere
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is B97.31 an HCC code?
No. B97.31 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
B97.31 is the ICD-10-CM diagnosis code for lentivirus as the cause of diseases classified elsewhere. Lentivirus (a slow-acting retrovirus) is identified as the underlying cause of another disease or condition being treated. B97.31 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).
B97.31 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.
This is a secondary code used with a primary diagnosis code that describes the actual disease caused by the lentivirus.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for B97.31 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a secondary code used with a primary diagnosis code that describes the actual disease caused by the lentivirus
- •Common lentiviruses include HIV; use this code only when the specific lentivirus type doesn't have its own dedicated code