B97.4 Respiratory syncytial virus as the cause of diseases classified elsewhere

BillableNo payment HCCChapter 1

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Instructional notes

Chapter 1

Excludes2Not included here: the patient may have both; report both when both are present.

carrier or suspected carrier of infectious disease (Z22.-)
certain localized infections - see body system-related chapters
infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium (O98.-)
infectious and parasitic diseases specific to the perinatal period (P35-P39)
influenza and other acute respiratory infections (J00-J22)

Use additional codeAdd a second code for the full picture.

code to identify resistance to antimicrobial drugs (Z16.-)

Includes

diseases generally recognized as communicable or transmissible

Section B95-B97

Notes

These categories are provided for use as supplementary or additional codes to identify the infectious agent(s) in diseases classified elsewhere.

This code

Excludes1Not coded here: never report with this code, except when the two conditions are unrelated.

acute bronchiolitis due to respiratory syncytial virus (RSV) (J21.0)
acute bronchitis due to respiratory syncytial virus (RSV) (J20.5)
respiratory syncytial virus (RSV) pneumonia (J12.1)

Code firstSequence the underlying condition first.

related disorders, such as:
otitis media (H65.-)
upper respiratory infection (J06.9)

Inclusion terms

RSV as the cause of diseases classified elsewhere

Chapter 1: Certain infectious and parasitic diseases · B95-B97 Bacterial and viral infectious agents (B95-B97)

Source: ICD-10-CM FY 2027 code descriptions and tabular list (CMS and CDC National Center for Health Statistics), effective 2026-10-01 through 2027-09-30 · CMS ICD-10 files. HCC mapping: CMS-HCC V28, payment year 2027. As of 2026-11-04.

Coverage and payment depend on the claim details; confirm with the Medicare Administrative Contractor.