B97.35
BillableHuman immunodeficiency virus, type 2 [HIV 2] 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 B97.35 an HCC code?
Yes. B97.35 maps to HIV/AIDS under the CMS-HCC V28 risk adjustment model (and HIV/AIDS under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for B97.35
For B97.35 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed B97.35 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
B97.35 is the ICD-10-CM diagnosis code for human immunodeficiency virus, type 2 [hiv 2] as the cause of diseases classified elsewhere. Human immunodeficiency virus type 2 (HIV-2) is identified as the underlying cause of another disease or condition being treated. B97.35 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).
Under the CMS-HCC V28 risk adjustment model, B97.35 maps to HIV/AIDS (HCC 1) with a community, non-dual, aged base RAF weight of 0.309. Under the older V24 model, B97.35 mapped to the same category but with a base RAF weight of 0.311 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This code is used when HIV-2 (rather than HIV-1) is the causative agent; pair with the primary diagnosis code for the opportunistic infection or AIDS-related condition. Because B97.35 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for B97.35 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is used when HIV-2 (rather than HIV-1) is the causative agent; pair with the primary diagnosis code for the opportunistic infection or AIDS-related condition
- •HIV-2 is less common than HIV-1 but follows similar coding principles with secondary code usage
Clinical Significance
HIV-2 as cause of disease classified elsewhere identifies the specific viral strain when HIV-2 is the underlying etiology. HIV-2 is less common globally than HIV-1 and is primarily found in West Africa. It progresses more slowly and is inherently resistant to non-nucleoside reverse transcriptase inhibitors, making identification critical for treatment selection. This code maps to the highest-tier HIV/AIDS HCC.
Documentation Requirements
- ✓Confirmatory HIV-2 serologic testing (HIV-2 specific Western blot or differentiation assay)
- ✓Documentation that the infection is specifically HIV-2, not HIV-1 or dual infection
- ✓The primary manifestation/condition being caused by HIV-2 must also be coded
- ✓Current antiretroviral regimen documented (noting NNRTI resistance)
- ✓CD4 count and HIV-2 viral load if available