R06.5 ICD-10-CM Code: Mouth breathing
HCC Buddy Code Card
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FY 2026 Apr update / Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) / Symptoms and signs involving the circulatory and respiratory systems (R00-R09)
R06.5
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMouth breathing
Breathing through the mouth instead of the nose, often due to nasal obstruction or habit.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for R06.5 in this effective period.
Excludes 2
Official- dry mouth NOS (R68.2)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for R06.5 in this effective period.
Excludes 1
Official- acute respiratory distress syndrome (J80)
- respiratory arrest (R09.2)
- respiratory arrest of newborn (P28.81)
- respiratory distress syndrome of newborn (P22.-)
- respiratory failure (J96.-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for R06.5 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for R06.5 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for R06.5 in this effective period.
Buddy Documentation Tip
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 R06.5 an HCC code?
No. R06.5 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- R06.5
- Description
- Mouth breathing
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
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
R06.5 is the ICD-10-CM diagnosis code for mouth breathing. Breathing through the mouth instead of the nose, often due to nasal obstruction or habit. R06.5 sits in the ICD-10-CM chapter for symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (r00-r99), within the section covering symptoms and signs involving the circulatory and respiratory systems (r00-r09).
R06.5 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.
Investigate and code any underlying nasal obstruction or sleep-related breathing disorder.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R06.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Investigate and code any underlying nasal obstruction or sleep-related breathing disorder
- •This is often a symptom rather than a primary diagnosis; focus on identifying the root cause
Excludes 2, Not included here, may code separately
- dry mouth NOS (R68.2)