2026 ICD-10-CM Diagnosis Code J15.211Pneumonia due to Methicillin susceptible Staphylococcus aureus
ICD-10-CM Codes›J00–J99›J09-J18›J15
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 282
- Not Chronic
J15.211 is a billable ICD-10-CM diagnosis code for pneumonia due to Methicillin susceptible Staphylococcus aureus. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 177 through 179, 791, 793, 974 through 976. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 129 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Bacterial infections and Pneumonia (except that caused by tuberculosis).
For Medicare Advantage risk adjustment, J15.211 maps to CMS-HCC Category 282 (Aspiration and Specified Bacterial Pneumonias) under the V28 model, adding a risk factor of about 0.440 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
J15.211 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Bronchopneumonia caused by methicillin susceptible Staphylococcus aureus
- Bronchopneumonia caused by Staphylococcus
- Bronchopneumonia caused by Staphylococcus aureus
- Infection by methicillin sensitive Staphylococcus aureus
- Infection caused by Panton-Valentine leukocidin producing Staphylococcus aureus
- Necrotizing pneumonia caused by Panton-Valentine leukocidin producing Staphylococcus aureus
- Pneumonia caused by methicillin susceptible Staphylococcus aureus
- Pneumonia caused by Staphylococcus aureus
- Pulmonary necrosis
- Staphylococcal pneumonia
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Inclusion Terms
- MSSA pneumonia
- Pneumonia due to Staphylococcus aureus NOS
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Pneumonia
Pneumonia is an infection in one or both of your lungs. It causes the air sacs of your lungs to fill up with fluid or pus. Pneumonia can range from mild to severe, depending on what caused it, your age, and your overall health.
The full article covers:
- What is pneumonia?
- What causes pneumonia?
- Who is more likely to develop pneumonia?
- What are the symptoms of pneumonia?
- What other problems can pneumonia cause?
- How is pneumonia diagnosed?
- What are the treatments for pneumonia?
- Can pneumonia be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert J15.211 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About J15.211Overview
What is the ICD-10 code for pneumonia due to Methicillin susceptible Staphylococcus aureus?
The ICD-10-CM code for pneumonia due to Methicillin susceptible Staphylococcus aureus is J15.211 (sometimes written as J15211). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is J15.211 (Pneumonia due to staphylococcus aureus) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report pneumonia due to Methicillin susceptible Staphylococcus aureus on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does J15.211 group to?
When pneumonia due to Methicillin susceptible Staphylococcus aureus is the principal diagnosis on an inpatient stay, it groups to MS-DRG 177, 178, 179, 791, 793, 974, 975, 976, with relative weights from 0.7550 to 4.1696 depending on complications. Higher weights mean higher Medicare reimbursement.
Is J15.211 a CC or MCC?
CMS lists J15.211 as an MCC (major complication or comorbidity) for FY 2026. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 129 closely related codes in its exclusion list.
What is the ICD-9 equivalent of J15.211?
Under the General Equivalence Mappings, pneumonia due to Methicillin susceptible Staphylococcus aureus converts to ICD-9-CM 482.41 (meth sus pneum d/t Staph). The mapping is a direct match.
What HCC is J15.211?
J15.211 (pneumonia due to Methicillin susceptible Staphylococcus aureus) maps to CMS-HCC Category 282 (Aspiration and Specified Bacterial Pneumonias), commonly written as HCC 282, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 114 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does J15.211 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, J15.211 adds a risk adjustment factor of about 0.440 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.173 to 0.538 depending on the payment segment). HCC 282 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 282 category page.
