2027 ICD-10-CM Diagnosis Code L12.1Cicatricial pemphigoid
ICD-10-CM Codes›L00–L99›L10-L14›L12
- Billable — Valid for Submission
- Risk Adjusts — HCC 387
- Chronic Condition
L12.1 is a billable ICD-10-CM diagnosis code for cicatricial pemphigoid. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 595 through 596. Coders also document this condition as autoimmune bullous dermatosis due to drug. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified inflammatory condition of skin.
For Medicare Advantage risk adjustment, L12.1 maps to CMS-HCC Category 387 (Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders) under the V28 model, adding a risk factor of about 0.406 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
L12.1 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 2027.
Source: CMS Payment Year 2027 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.
- Autoimmune bullous dermatosis due to drug
- Benign mucous membrane pemphigoid
- Benign mucous membrane pemphigoid with ocular involvement
- Brunsting-Perry type cicatricial pemphigoid
- Bullous dermatosis precipitated by drug treatment
- Drug-induced cicatricial pemphigoid
- Mucous membrane pemphigoid of penile mucosa
- Mucous membrane pemphigoid with esophageal involvement
- Ocular cicatricial pemphigoid
- Oral involvement by mucous membrane pemphigoid
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to L12.1: its own notes plus those printed at L12, block L10-L14, and Chapter 12. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Benign mucous membrane pemphigoid
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- lipomelanotic reticulosis (I89.8)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- systemic connective tissue disorders (M30-M36)
- viral warts (B07.-)
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
benign, mucous membrane L12.1
cicatricial L12.1
ocular L12.1
conjunctiva L12.1
ocular L12.1
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Pemphigoid, Benign Mucous Membrane
a chronic blistering disease with predilection for mucous membranes and less frequently the skin, and with a tendency to scarring. it is sometimes called ocular pemphigoid because of conjunctival mucous membrane involvement.
Patient EducationClinical
Pemphigus
Pemphigus is an autoimmune disorder. If you have it, your immune system attacks healthy cells in your skin and mouth, causing blisters and sores. No one knows the cause. Pemphigus does not spread from person to person. It does not appear to be inherited. But some people's genes put them more at risk for pemphigus.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert L12.1 to ICD-9-CMHistory
Code HistoryHistory
Questions About L12.1Overview
What is the ICD-10 code for cicatricial pemphigoid?
The ICD-10-CM code for cicatricial pemphigoid is L12.1 (sometimes written as L121). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is L12.1 (Pemphigoid) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report cicatricial pemphigoid on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does L12.1 group to?
When cicatricial pemphigoid is the principal diagnosis on an inpatient stay, it groups to MS-DRG 596, 595, with relative weights from 1.1067 to 2.0230 depending on complications. Higher weights mean higher Medicare reimbursement.
Can L12.1 be reported with a code from O26.4?
Not as a rule. The Excludes1 note at L12, which applies to L12.1, lists "herpes gestationis (O26.4-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What is the ICD-9 equivalent of L12.1?
Under the General Equivalence Mappings, cicatricial pemphigoid converts to ICD-9-CM 694.60 (bn mucous memb pemph NOS) and 694.61 (ocular pemphigus). The mapping is approximate, so confirm the match fits the documentation.
What HCC is L12.1?
L12.1 (cicatricial pemphigoid) maps to CMS-HCC Category 387 (Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders), commonly written as HCC 387, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. In the Part D prescription drug model it maps to RxHCC 314.
Does L12.1 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, L12.1 adds a risk adjustment factor of about 0.406 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.125 to 0.658 depending on the payment segment). HCC 387 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 387 category page.
