J16.8: Pneumonia due to other specified infectious organisms
J16.8, pneumonia due to other specified infectious organisms, is listed as a covered diagnosis in 5 Medicare billing and coding articles that apply to 55 HCPCS Level II codes, including U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19)…), U0001 (Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr…), K0730 (Controlled dose inhalation drug delivery system). 20 of these codes have a 2026 DMEPOS fee schedule amount; K0730 pays $245.69 (RR) depending on the state. The articles come from 4 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with J16.8 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc | Carrier judgment | — | 4 |
| U0001 | Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel | Carrier judgment | — | 4 |
| K0730 | Controlled dose inhalation drug delivery system | Carrier judgment | $245.69 (RR) | 1 |
| E1372 | Immersion external heater for nebulizer | Special coverage instructions apply | $136.61–$208.94 (NU) | 1 |
| A7017 | Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen | Special coverage instructions apply | $130.82–$194.58 (NU) | 1 |
| E0580 | Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter | Special coverage instructions apply | $164.65–$182.27 (NU) | 1 |
| E0575 | Nebulizer, ultrasonic, large volume | Special coverage instructions apply | $124.51–$159.48 (RR) | 1 |
| E0565 | Compressor, air power source for equipment which is not self-contained or cylinder driven | Carrier judgment | $42.74–$82.96 (RR) | 1 |
| E0574 | Ultrasonic/electronic aerosol generator with small volume nebulizer | Carrier judgment | $48.76–$67.63 (RR) | 1 |
| E0585 | Nebulizer, with compressor and heater | Special coverage instructions apply | $32.06–$60.76 (RR) | 1 |
| E0572 | Aerosol compressor, adjustable pressure, light duty for intermittent use | Carrier judgment | $29.16–$51.74 (RR) | 1 |
| A7005 | Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable | Carrier judgment | $11.77–$29.20 (NU) | 1 |
| A7008 | Large volume nebulizer, disposable, prefilled, used with aerosol compressor | Carrier judgment | $12.46–$18.09 (NU) | 1 |
| A7016 | Dome and mouthpiece, used with small volume ultrasonic nebulizer | Carrier judgment | $9.31–$17.75 (NU) | 1 |
| E0570 | Nebulizer, with compressor | Special coverage instructions apply | $6.09–$15.43 (RR) | 1 |
| A7006 | Administration set, with small volume filtered pneumatic nebulizer | Carrier judgment | $8.19–$14.94 (NU) | 1 |
| A7007 | Large volume nebulizer, disposable, unfilled, used with aerosol compressor | Carrier judgment | $3.47–$5.87 (NU) | 1 |
| A7012 | Water collection device, used with large volume nebulizer | Carrier judgment | $3.25–$5.03 (NU) | 1 |
| A4217 | Sterile water/saline, 500 ml | Special coverage instructions apply | $2.18–$4.93 | 1 |
| A7003 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable | Carrier judgment | $1.86–$3.26 (NU) | 1 |
| A7004 | Small volume nonfiltered pneumatic nebulizer, disposable | Carrier judgment | $1.51–$2.08 (NU) | 1 |
| A7018 | Water, distilled, used with large volume nebulizer, 1000 ml | Carrier judgment | $0.38–$0.59 | 1 |
| J7677 | Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram | Carrier judgment | — | 1 |
| J7613 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg | Special coverage instructions apply | — | 1 |
| J7620 | Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme | Special coverage instructions apply | — | 1 |
30 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing J16.8
- A52466: Nebulizers - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 53 Level II codes). LCD with the same title: L33370
- A58710: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (Palmetto GBA (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58720: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58761: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58747: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other J16 diagnoses (Pneumonia due to other infectious organisms, not elsewhere classified)
- J16.0 — Chlamydial pneumonia
Frequently asked questions
Does Medicare cover J16.8 (Pneumonia due to other specified infectious organisms)?
Medicare covers items and services, not diagnoses. 5 Medicare billing and coding articles list J16.8 as a covered diagnosis for 55 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 J16.8?
The Level II codes from the policies most specific to this diagnosis are U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19)…, 4 articles); U0001 (Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr…, 4 articles); K0730 (Controlled dose inhalation drug delivery system, 1 article); E1372 (Immersion external heater for nebulizer, 1 article); A7017 (Nebulizer, durable, glass or autoclavable plastic, bottle…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with J16.8?
Under the 2026 DMEPOS fee schedule (non-rural state fees): K0730 $245.69 (RR); E1372 $136.61 to $208.94 (NU); A7017 $130.82 to $194.58 (NU); E0580 $164.65 to $182.27 (NU). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list J16.8?
A52466 (Nebulizers - Policy Article); A58710 (Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing); A58720 (Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing), and 2 more articles.
What is ICD-10-CM code J16.8?
J16.8 is the ICD-10-CM code for pneumonia due to other specified infectious organisms, in category J16 (Pneumonia due to other infectious organisms, not elsewhere classified), chapter 10: Diseases of the respiratory system.
Next steps
- Run a reimbursement report for a device billed under U0002
- Watch U0002 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for U0002
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 10: Diseases of the respiratory system · All diagnoses · HCPCS lookup