B48.4: Penicillosis

Risk adjustment

B48.4 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 6 Opportunistic Infections0.381 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

B48.4 is named in 5 Medicare coverage policies: 5 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
• A56612Billing and Coding: CT of the Head
• A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
• A57204Billing and Coding: MRI and CT Scans of the Head and Neck