R85.81 ICD-10-CM Code: Anal high risk human papillomavirus (HPV) DNA test positive
R85.81 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC Buddy coding tools
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FY 2026 Apr update / Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) / Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (R83-R89)
R85.81
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAnal high risk human papillomavirus (HPV) DNA test positive
A test of anal tissue shows the presence of high-risk types of human papillomavirus (HPV), which are associated with increased cancer risk.
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 R85.81 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for R85.81 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for R85.81 in this effective period.
Excludes 1
Official- anogenital warts due to human papillomavirus (HPV) (A63.0)
- condyloma acuminatum (A63.0)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for R85.81 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for R85.81 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for R85.81 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 R85.81 an HCC code?
No. R85.81 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- R85.81
- Description
- Anal high risk human papillomavirus (HPV) DNA test positive
- 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
R85.81 is the ICD-10-CM diagnosis code for anal high risk human papillomavirus (hpv) dna test positive. A test of anal tissue shows the presence of high-risk types of human papillomavirus (HPV), which are associated with increased cancer risk. R85.81 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 abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (r83-r89).
R85.81 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.
Document the specific HPV type(s) identified when available for risk stratification and follow-up planning.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R85.81 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific HPV type(s) identified when available for risk stratification and follow-up planning
- •High-risk HPV findings typically warrant closer surveillance or additional diagnostic procedures