Policy source
The recorded policy does not contain a public text excerpt. Read the official source for details.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
Showing the first 1,000 of 19,328 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 29105 | HCPCS | Covered |
| 29125 | HCPCS | Covered |
| 29126 | HCPCS | Covered |
| 29130 | HCPCS | Covered |
| 29131 | HCPCS | Covered |
| 29200 | HCPCS | Covered |
| 29240 | HCPCS | Covered |
| 29260 | HCPCS | Covered |
| 29280 | HCPCS | Covered |
| 29505 | HCPCS | Covered |
| 29515 | HCPCS | Covered |
| 29520 | HCPCS | Covered |
| 29530 | HCPCS | Covered |
| 29540 | HCPCS | Covered |
| 29550 | HCPCS | Covered |
| 29580 | HCPCS | Covered |
| 29799 | HCPCS | Covered |
| 90901 | HCPCS | Covered |
| 95851 | HCPCS | Covered |
| 95852 | HCPCS | Covered |
| 97010 | HCPCS | Covered |
| 97012 | HCPCS | Covered |
| 97016 | HCPCS | Covered |
| 97018 | HCPCS | Covered |
| 97022 | HCPCS | Covered |
| 97024 | HCPCS | Covered |
| 97026 | HCPCS | Covered |
| 97032 | HCPCS | Covered |
| 97034 | HCPCS | Covered |
| 97035 | HCPCS | Covered |
| 97110 | HCPCS | Covered |
| 97112 | HCPCS | Covered |
| 97116 | HCPCS | Covered |
| 97124 | HCPCS | Covered |
| 97140 | HCPCS | Covered |
| 97161 | HCPCS | Covered |
| 97162 | HCPCS | Covered |
| 97163 | HCPCS | Covered |
| 97164 | HCPCS | Covered |
| 97530 | HCPCS | Covered |
| 97533 | HCPCS | Covered |
| 97535 | HCPCS | Covered |
| 97537 | HCPCS | Covered |
| 97542 | HCPCS | Covered |
| 97545 | HCPCS | Covered |
| 97546 | HCPCS | Covered |
| 97550 | HCPCS | Covered |
| 97551 | HCPCS | Covered |
| 97750 | HCPCS | Covered |
| 97755 | HCPCS | Covered |
| 97760 | HCPCS | Covered |
| 97761 | HCPCS | Covered |
| 97763 | HCPCS | Covered |
| G0151 | HCPCS | Covered |
| G0157 | HCPCS | Covered |
| G0159 | HCPCS | Covered |
| G0329 | HCPCS | Covered |
| G2168 | HCPCS | Covered |
| L1972 | HCPCS | Covered |
| A18.01 | ICD10CM | Covered |
| B91 | ICD10CM | Covered |
| E08.40 | ICD10CM | Covered |
| E08.42 | ICD10CM | Covered |
| E08.44 | ICD10CM | Covered |
| E08.52 | ICD10CM | Covered |
| E09.40 | ICD10CM | Covered |
| E09.42 | ICD10CM | Covered |
| E09.44 | ICD10CM | Covered |
| E09.52 | ICD10CM | Covered |
| E10.40 | ICD10CM | Covered |
| E10.42 | ICD10CM | Covered |
| E10.44 | ICD10CM | Covered |
| E10.52 | ICD10CM | Covered |
| E11.40 | ICD10CM | Covered |
| E11.42 | ICD10CM | Covered |
| E11.44 | ICD10CM | Covered |
| E11.52 | ICD10CM | Covered |
| E13.40 | ICD10CM | Covered |
| E13.42 | ICD10CM | Covered |
| E13.44 | ICD10CM | Covered |
| E13.52 | ICD10CM | Covered |
| G04.1 | ICD10CM | Covered |
| G04.82 | ICD10CM | Covered |
| G11.10 | ICD10CM | Covered |
| G11.11 | ICD10CM | Covered |
| G11.19 | ICD10CM | Covered |
| G12.23 | ICD10CM | Covered |
| G12.24 | ICD10CM | Covered |
| G12.25 | ICD10CM | Covered |
| G14 | ICD10CM | Covered |
| G24.01 | ICD10CM | Covered |
| G24.02 | ICD10CM | Covered |
| G24.09 | ICD10CM | Covered |
| G24.2 | ICD10CM | Covered |
| G24.3 | ICD10CM | Covered |
| G24.8 | ICD10CM | Covered |
| G25.82 | ICD10CM | Covered |
| G31.80 | ICD10CM | Covered |
| G31.85 | ICD10CM | Covered |
| G31.86 | ICD10CM | Covered |
| G51.0 | ICD10CM | Covered |
| G54.0 | ICD10CM | Covered |
| G54.1 | ICD10CM | Covered |
| G54.2 | ICD10CM | Covered |
| G54.3 | ICD10CM | Covered |
| G54.4 | ICD10CM | Covered |
| G54.5 | ICD10CM | Covered |
| G54.6 | ICD10CM | Covered |
| G54.7 | ICD10CM | Covered |
| G54.8 | ICD10CM | Covered |
| G55 | ICD10CM | Covered |
| G56.01 | ICD10CM | Covered |
| G56.02 | ICD10CM | Covered |
| G56.03 | ICD10CM | Covered |
| G56.11 | ICD10CM | Covered |
| G56.12 | ICD10CM | Covered |
| G56.13 | ICD10CM | Covered |
| G56.21 | ICD10CM | Covered |
| G56.22 | ICD10CM | Covered |
| G56.23 | ICD10CM | Covered |
| G56.31 | ICD10CM | Covered |
| G56.32 | ICD10CM | Covered |
| G56.33 | ICD10CM | Covered |
| G56.41 | ICD10CM | Covered |
| G56.42 | ICD10CM | Covered |
| G56.43 | ICD10CM | Covered |
| G56.81 | ICD10CM | Covered |
| G56.82 | ICD10CM | Covered |
| G56.83 | ICD10CM | Covered |
| G56.93 | ICD10CM | Covered |
| G57.01 | ICD10CM | Covered |
| G57.02 | ICD10CM | Covered |
| G57.03 | ICD10CM | Covered |
| G57.11 | ICD10CM | Covered |
| G57.12 | ICD10CM | Covered |
| G57.13 | ICD10CM | Covered |
| G57.21 | ICD10CM | Covered |
| G57.22 | ICD10CM | Covered |
| G57.23 | ICD10CM | Covered |
| G57.31 | ICD10CM | Covered |
| G57.32 | ICD10CM | Covered |
| G57.33 | ICD10CM | Covered |
| G57.41 | ICD10CM | Covered |
| G57.42 | ICD10CM | Covered |
| G57.43 | ICD10CM | Covered |
| G57.51 | ICD10CM | Covered |
| G57.52 | ICD10CM | Covered |
| G57.53 | ICD10CM | Covered |
| G57.61 | ICD10CM | Covered |
| G57.62 | ICD10CM | Covered |
| G57.63 | ICD10CM | Covered |
| G57.71 | ICD10CM | Covered |
| G57.72 | ICD10CM | Covered |
| G57.73 | ICD10CM | Covered |
| G57.81 | ICD10CM | Covered |
| G57.82 | ICD10CM | Covered |
| G57.83 | ICD10CM | Covered |
| G57.91 | ICD10CM | Covered |
| G57.92 | ICD10CM | Covered |
| G57.93 | ICD10CM | Covered |
| G58.0 | ICD10CM | Covered |
| G58.7 | ICD10CM | Covered |
| G60.0 | ICD10CM | Covered |
| G60.1 | ICD10CM | Covered |
| G60.2 | ICD10CM | Covered |
| G60.3 | ICD10CM | Covered |
| G60.8 | ICD10CM | Covered |
| G61.0 | ICD10CM | Covered |
| G61.82 | ICD10CM | Covered |
| G70.81 | ICD10CM | Covered |
| G71.031 | ICD10CM | Covered |
| G71.032 | ICD10CM | Covered |
| G71.033 | ICD10CM | Covered |
| G71.0340 | ICD10CM | Covered |
| G71.0341 | ICD10CM | Covered |
| G71.0342 | ICD10CM | Covered |
| G71.0349 | ICD10CM | Covered |
| G71.035 | ICD10CM | Covered |
| G71.036 | ICD10CM | Covered |
| G71.038 | ICD10CM | Covered |
| G71.11 | ICD10CM | Covered |
| G71.12 | ICD10CM | Covered |
| G71.13 | ICD10CM | Covered |
| G71.14 | ICD10CM | Covered |
| G71.19 | ICD10CM | Covered |
| G71.20 | ICD10CM | Covered |
| G71.21 | ICD10CM | Covered |
| G71.220 | ICD10CM | Covered |
| G71.228 | ICD10CM | Covered |
| G71.29 | ICD10CM | Covered |
| G72.41 | ICD10CM | Covered |
| G72.49 | ICD10CM | Covered |
| G73.1 | ICD10CM | Covered |
| G80.0 | ICD10CM | Covered |
| G80.1 | ICD10CM | Covered |
| G80.2 | ICD10CM | Covered |
| G80.3 | ICD10CM | Covered |
| G80.4 | ICD10CM | Covered |
| G80.8 | ICD10CM | Covered |
| G80.9 | ICD10CM | Covered |
| G81.01 | ICD10CM | Covered |
| G81.02 | ICD10CM | Covered |
| G81.03 | ICD10CM | Covered |
| G81.04 | ICD10CM | Covered |
| G81.11 | ICD10CM | Covered |
| G81.12 | ICD10CM | Covered |
| G81.13 | ICD10CM | Covered |
| G81.14 | ICD10CM | Covered |
| G81.91 | ICD10CM | Covered |
| G81.92 | ICD10CM | Covered |
| G81.93 | ICD10CM | Covered |
| G81.94 | ICD10CM | Covered |
| G82.21 | ICD10CM | Covered |
| G82.22 | ICD10CM | Covered |
| G82.51 | ICD10CM | Covered |
| G82.52 | ICD10CM | Covered |
| G82.53 | ICD10CM | Covered |
| G82.54 | ICD10CM | Covered |
| G83.0 | ICD10CM | Covered |
| G83.11 | ICD10CM | Covered |
| G83.12 | ICD10CM | Covered |
| G83.13 | ICD10CM | Covered |
| G83.14 | ICD10CM | Covered |
| G83.21 | ICD10CM | Covered |
| G83.22 | ICD10CM | Covered |
| G83.23 | ICD10CM | Covered |
| G83.24 | ICD10CM | Covered |
| G83.4 | ICD10CM | Covered |
| G83.5 | ICD10CM | Covered |
| G83.81 | ICD10CM | Covered |
| G83.82 | ICD10CM | Covered |
| G83.83 | ICD10CM | Covered |
| G83.84 | ICD10CM | Covered |
| G83.89 | ICD10CM | Covered |
| G90.2 | ICD10CM | Covered |
| G90.4 | ICD10CM | Covered |
| G90.511 | ICD10CM | Covered |
| G90.512 | ICD10CM | Covered |
| G90.513 | ICD10CM | Covered |
| G90.521 | ICD10CM | Covered |
| G90.522 | ICD10CM | Covered |
| G90.523 | ICD10CM | Covered |
| G90.59 | ICD10CM | Covered |
| H81.11 | ICD10CM | Covered |
| H81.12 | ICD10CM | Covered |
| H81.13 | ICD10CM | Covered |
| I69.010 | ICD10CM | Covered |
| I69.011 | ICD10CM | Covered |
| I69.012 | ICD10CM | Covered |
| I69.013 | ICD10CM | Covered |
| I69.014 | ICD10CM | Covered |
| I69.015 | ICD10CM | Covered |
| I69.018 | ICD10CM | Covered |
| I69.019 | ICD10CM | Covered |
| I69.031 | ICD10CM | Covered |
| I69.032 | ICD10CM | Covered |
| I69.033 | ICD10CM | Covered |
| I69.034 | ICD10CM | Covered |
| I69.041 | ICD10CM | Covered |
| I69.042 | ICD10CM | Covered |
| I69.043 | ICD10CM | Covered |
| I69.044 | ICD10CM | Covered |
| I69.051 | ICD10CM | Covered |
| I69.052 | ICD10CM | Covered |
| I69.053 | ICD10CM | Covered |
| I69.054 | ICD10CM | Covered |
| I69.063 | ICD10CM | Covered |
| I69.064 | ICD10CM | Covered |
| I69.065 | ICD10CM | Covered |
| I69.090 | ICD10CM | Covered |
| I69.091 | ICD10CM | Covered |
| I69.092 | ICD10CM | Covered |
| I69.093 | ICD10CM | Covered |
| I69.110 | ICD10CM | Covered |
| I69.111 | ICD10CM | Covered |
| I69.112 | ICD10CM | Covered |
| I69.113 | ICD10CM | Covered |
| I69.114 | ICD10CM | Covered |
| I69.115 | ICD10CM | Covered |
| I69.118 | ICD10CM | Covered |
| I69.119 | ICD10CM | Covered |
| I69.131 | ICD10CM | Covered |
| I69.132 | ICD10CM | Covered |
| I69.133 | ICD10CM | Covered |
| I69.134 | ICD10CM | Covered |
| I69.141 | ICD10CM | Covered |
| I69.142 | ICD10CM | Covered |
| I69.143 | ICD10CM | Covered |
| I69.144 | ICD10CM | Covered |
| I69.151 | ICD10CM | Covered |
| I69.152 | ICD10CM | Covered |
| I69.153 | ICD10CM | Covered |
| I69.154 | ICD10CM | Covered |
| I69.163 | ICD10CM | Covered |
| I69.164 | ICD10CM | Covered |
| I69.165 | ICD10CM | Covered |
| I69.190 | ICD10CM | Covered |
| I69.191 | ICD10CM | Covered |
| I69.192 | ICD10CM | Covered |
| I69.193 | ICD10CM | Covered |
| I69.210 | ICD10CM | Covered |
| I69.211 | ICD10CM | Covered |
| I69.212 | ICD10CM | Covered |
| I69.213 | ICD10CM | Covered |
| I69.214 | ICD10CM | Covered |
| I69.215 | ICD10CM | Covered |
| I69.218 | ICD10CM | Covered |
| I69.219 | ICD10CM | Covered |
| I69.231 | ICD10CM | Covered |
| I69.232 | ICD10CM | Covered |
| I69.233 | ICD10CM | Covered |
| I69.234 | ICD10CM | Covered |
| I69.241 | ICD10CM | Covered |
| I69.242 | ICD10CM | Covered |
| I69.243 | ICD10CM | Covered |
| I69.244 | ICD10CM | Covered |
| I69.251 | ICD10CM | Covered |
| I69.252 | ICD10CM | Covered |
| I69.253 | ICD10CM | Covered |
| I69.254 | ICD10CM | Covered |
| I69.263 | ICD10CM | Covered |
| I69.264 | ICD10CM | Covered |
| I69.265 | ICD10CM | Covered |
| I69.290 | ICD10CM | Covered |
| I69.291 | ICD10CM | Covered |
| I69.292 | ICD10CM | Covered |
| I69.293 | ICD10CM | Covered |
| I69.310 | ICD10CM | Covered |
| I69.311 | ICD10CM | Covered |
| I69.312 | ICD10CM | Covered |
| I69.313 | ICD10CM | Covered |
| I69.314 | ICD10CM | Covered |
| I69.315 | ICD10CM | Covered |
| I69.318 | ICD10CM | Covered |
| I69.319 | ICD10CM | Covered |
| I69.331 | ICD10CM | Covered |
| I69.332 | ICD10CM | Covered |
| I69.333 | ICD10CM | Covered |
| I69.334 | ICD10CM | Covered |
| I69.341 | ICD10CM | Covered |
| I69.342 | ICD10CM | Covered |
| I69.343 | ICD10CM | Covered |
| I69.344 | ICD10CM | Covered |
| I69.351 | ICD10CM | Covered |
| I69.352 | ICD10CM | Covered |
| I69.353 | ICD10CM | Covered |
| I69.354 | ICD10CM | Covered |
| I69.363 | ICD10CM | Covered |
| I69.364 | ICD10CM | Covered |
| I69.365 | ICD10CM | Covered |
| I69.390 | ICD10CM | Covered |
| I69.391 | ICD10CM | Covered |
| I69.392 | ICD10CM | Covered |
| I69.393 | ICD10CM | Covered |
| I69.810 | ICD10CM | Covered |
| I69.811 | ICD10CM | Covered |
| I69.812 | ICD10CM | Covered |
| I69.813 | ICD10CM | Covered |
| I69.814 | ICD10CM | Covered |
| I69.815 | ICD10CM | Covered |
| I69.818 | ICD10CM | Covered |
| I69.831 | ICD10CM | Covered |
| I69.832 | ICD10CM | Covered |
| I69.833 | ICD10CM | Covered |
| I69.834 | ICD10CM | Covered |
| I69.841 | ICD10CM | Covered |
| I69.842 | ICD10CM | Covered |
| I69.843 | ICD10CM | Covered |
| I69.844 | ICD10CM | Covered |
| I69.851 | ICD10CM | Covered |
| I69.852 | ICD10CM | Covered |
| I69.853 | ICD10CM | Covered |
| I69.854 | ICD10CM | Covered |
| I69.863 | ICD10CM | Covered |
| I69.864 | ICD10CM | Covered |
| I69.865 | ICD10CM | Covered |
| I69.890 | ICD10CM | Covered |
| I69.891 | ICD10CM | Covered |
| I69.892 | ICD10CM | Covered |
| I69.893 | ICD10CM | Covered |
| I69.910 | ICD10CM | Covered |
| I69.911 | ICD10CM | Covered |
| I69.912 | ICD10CM | Covered |
| I69.913 | ICD10CM | Covered |
| I69.914 | ICD10CM | Covered |
| I69.915 | ICD10CM | Covered |
| I69.918 | ICD10CM | Covered |
| I69.931 | ICD10CM | Covered |
| I69.932 | ICD10CM | Covered |
| I69.933 | ICD10CM | Covered |
| I69.934 | ICD10CM | Covered |
| I69.941 | ICD10CM | Covered |
| I69.942 | ICD10CM | Covered |
| I69.943 | ICD10CM | Covered |
| I69.944 | ICD10CM | Covered |
| I69.951 | ICD10CM | Covered |
| I69.952 | ICD10CM | Covered |
| I69.953 | ICD10CM | Covered |
| I69.954 | ICD10CM | Covered |
| I69.963 | ICD10CM | Covered |
| I69.964 | ICD10CM | Covered |
| I69.965 | ICD10CM | Covered |
| I69.990 | ICD10CM | Covered |
| I69.991 | ICD10CM | Covered |
| I69.992 | ICD10CM | Covered |
| I69.993 | ICD10CM | Covered |
| I69.998 | ICD10CM | Covered |
| I70.231 | ICD10CM | Covered |
| I70.232 | ICD10CM | Covered |
| I70.233 | ICD10CM | Covered |
| I70.234 | ICD10CM | Covered |
| I70.235 | ICD10CM | Covered |
| I70.238 | ICD10CM | Covered |
| I70.241 | ICD10CM | Covered |
| I70.242 | ICD10CM | Covered |
| I70.243 | ICD10CM | Covered |
| I70.244 | ICD10CM | Covered |
| I70.245 | ICD10CM | Covered |
| I70.248 | ICD10CM | Covered |
| I70.25 | ICD10CM | Covered |
| I70.331 | ICD10CM | Covered |
| I70.332 | ICD10CM | Covered |
| I70.333 | ICD10CM | Covered |
| I70.334 | ICD10CM | Covered |
| I70.335 | ICD10CM | Covered |
| I70.338 | ICD10CM | Covered |
| I70.341 | ICD10CM | Covered |
| I70.342 | ICD10CM | Covered |
| I70.343 | ICD10CM | Covered |
| I70.344 | ICD10CM | Covered |
| I70.345 | ICD10CM | Covered |
| I70.348 | ICD10CM | Covered |
| I70.35 | ICD10CM | Covered |
| I70.361 | ICD10CM | Covered |
| I70.362 | ICD10CM | Covered |
| I70.363 | ICD10CM | Covered |
| I70.368 | ICD10CM | Covered |
| I70.431 | ICD10CM | Covered |
| I70.432 | ICD10CM | Covered |
| I70.433 | ICD10CM | Covered |
| I70.434 | ICD10CM | Covered |
| I70.435 | ICD10CM | Covered |
| I70.438 | ICD10CM | Covered |
| I70.441 | ICD10CM | Covered |
| I70.442 | ICD10CM | Covered |
| I70.443 | ICD10CM | Covered |
| I70.444 | ICD10CM | Covered |
| I70.445 | ICD10CM | Covered |
| I70.448 | ICD10CM | Covered |
| I70.45 | ICD10CM | Covered |
| I70.461 | ICD10CM | Covered |
| I70.462 | ICD10CM | Covered |
| I70.463 | ICD10CM | Covered |
| I70.468 | ICD10CM | Covered |
| I70.531 | ICD10CM | Covered |
| I70.532 | ICD10CM | Covered |
| I70.533 | ICD10CM | Covered |
| I70.534 | ICD10CM | Covered |
| I70.535 | ICD10CM | Covered |
| I70.538 | ICD10CM | Covered |
| I70.541 | ICD10CM | Covered |
| I70.542 | ICD10CM | Covered |
| I70.543 | ICD10CM | Covered |
| I70.544 | ICD10CM | Covered |
| I70.545 | ICD10CM | Covered |
| I70.549 | ICD10CM | Covered |
| I70.55 | ICD10CM | Covered |
| I70.561 | ICD10CM | Covered |
| I70.562 | ICD10CM | Covered |
| I70.563 | ICD10CM | Covered |
| I70.568 | ICD10CM | Covered |
| I70.631 | ICD10CM | Covered |
| I70.632 | ICD10CM | Covered |
| I70.633 | ICD10CM | Covered |
| I70.634 | ICD10CM | Covered |
| I70.635 | ICD10CM | Covered |
| I70.638 | ICD10CM | Covered |
| I70.641 | ICD10CM | Covered |
| I70.642 | ICD10CM | Covered |
| I70.643 | ICD10CM | Covered |
| I70.644 | ICD10CM | Covered |
| I70.645 | ICD10CM | Covered |
| I70.648 | ICD10CM | Covered |
| I70.65 | ICD10CM | Covered |
| I70.661 | ICD10CM | Covered |
| I70.662 | ICD10CM | Covered |
| I70.663 | ICD10CM | Covered |
| I70.668 | ICD10CM | Covered |
| I70.731 | ICD10CM | Covered |
| I70.732 | ICD10CM | Covered |
| I70.733 | ICD10CM | Covered |
| I70.734 | ICD10CM | Covered |
| I70.735 | ICD10CM | Covered |
| I70.738 | ICD10CM | Covered |
| I70.741 | ICD10CM | Covered |
| I70.742 | ICD10CM | Covered |
| I70.743 | ICD10CM | Covered |
| I70.744 | ICD10CM | Covered |
| I70.745 | ICD10CM | Covered |
| I70.748 | ICD10CM | Covered |
| I70.75 | ICD10CM | Covered |
| I70.761 | ICD10CM | Covered |
| I70.762 | ICD10CM | Covered |
| I70.763 | ICD10CM | Covered |
| I70.768 | ICD10CM | Covered |
| I73.01 | ICD10CM | Covered |
| I83.011 | ICD10CM | Covered |
| I83.012 | ICD10CM | Covered |
| I83.013 | ICD10CM | Covered |
| I83.014 | ICD10CM | Covered |
| I83.015 | ICD10CM | Covered |
| I83.018 | ICD10CM | Covered |
| I83.021 | ICD10CM | Covered |
| I83.022 | ICD10CM | Covered |
| I83.023 | ICD10CM | Covered |
| I83.024 | ICD10CM | Covered |
| I83.025 | ICD10CM | Covered |
| I83.028 | ICD10CM | Covered |
| I83.11 | ICD10CM | Covered |
| I83.12 | ICD10CM | Covered |
| I83.211 | ICD10CM | Covered |
| I83.212 | ICD10CM | Covered |
| I83.213 | ICD10CM | Covered |
| I83.214 | ICD10CM | Covered |
| I83.215 | ICD10CM | Covered |
| I83.218 | ICD10CM | Covered |
| I83.221 | ICD10CM | Covered |
| I83.222 | ICD10CM | Covered |
| I83.223 | ICD10CM | Covered |
| I83.224 | ICD10CM | Covered |
| I83.225 | ICD10CM | Covered |
| I83.228 | ICD10CM | Covered |
| I83.811 | ICD10CM | Covered |
| I83.812 | ICD10CM | Covered |
| I83.813 | ICD10CM | Covered |
| I83.891 | ICD10CM | Covered |
| I83.892 | ICD10CM | Covered |
| I83.893 | ICD10CM | Covered |
| I87.311 | ICD10CM | Covered |
| I87.312 | ICD10CM | Covered |
| I87.313 | ICD10CM | Covered |
| I87.331 | ICD10CM | Covered |
| I87.332 | ICD10CM | Covered |
| I87.333 | ICD10CM | Covered |
| I89.0 | ICD10CM | Covered |
| I96 | ICD10CM | Covered |
| I97.2 | ICD10CM | Covered |
| J18.2 | ICD10CM | Covered |
| J81.1 | ICD10CM | Covered |
| K12.2 | ICD10CM | Covered |
| K68.11 | ICD10CM | Covered |
| L03.011 | ICD10CM | Covered |
| L03.012 | ICD10CM | Covered |
| L03.021 | ICD10CM | Covered |
| L03.022 | ICD10CM | Covered |
| L03.031 | ICD10CM | Covered |
| L03.032 | ICD10CM | Covered |
| L03.041 | ICD10CM | Covered |
| L03.042 | ICD10CM | Covered |
| L03.111 | ICD10CM | Covered |
| L03.112 | ICD10CM | Covered |
| L03.113 | ICD10CM | Covered |
| L03.114 | ICD10CM | Covered |
| L03.115 | ICD10CM | Covered |
| L03.116 | ICD10CM | Covered |
| L03.121 | ICD10CM | Covered |
| L03.122 | ICD10CM | Covered |
| L03.123 | ICD10CM | Covered |
| L03.124 | ICD10CM | Covered |
| L03.125 | ICD10CM | Covered |
| L03.126 | ICD10CM | Covered |
| L03.211 | ICD10CM | Covered |
| L03.212 | ICD10CM | Covered |
| L03.221 | ICD10CM | Covered |
| L03.222 | ICD10CM | Covered |
| L03.311 | ICD10CM | Covered |
| L03.312 | ICD10CM | Covered |
| L03.313 | ICD10CM | Covered |
| L03.314 | ICD10CM | Covered |
| L03.315 | ICD10CM | Covered |
| L03.316 | ICD10CM | Covered |
| L03.317 | ICD10CM | Covered |
| L03.31A | ICD10CM | Covered |
| L03.321 | ICD10CM | Covered |
| L03.322 | ICD10CM | Covered |
| L03.323 | ICD10CM | Covered |
| L03.324 | ICD10CM | Covered |
| L03.325 | ICD10CM | Covered |
| L03.326 | ICD10CM | Covered |
| L03.327 | ICD10CM | Covered |
| L03.32A | ICD10CM | Covered |
| L04.0 | ICD10CM | Covered |
| L04.1 | ICD10CM | Covered |
| L04.2 | ICD10CM | Covered |
| L04.3 | ICD10CM | Covered |
| L04.8 | ICD10CM | Covered |
| L59.9 | ICD10CM | Covered |
| L89.006 | ICD10CM | Covered |
| L89.010 | ICD10CM | Covered |
| L89.011 | ICD10CM | Covered |
| L89.012 | ICD10CM | Covered |
| L89.013 | ICD10CM | Covered |
| L89.014 | ICD10CM | Covered |
| L89.016 | ICD10CM | Covered |
| L89.020 | ICD10CM | Covered |
| L89.021 | ICD10CM | Covered |
| L89.022 | ICD10CM | Covered |
| L89.023 | ICD10CM | Covered |
| L89.024 | ICD10CM | Covered |
| L89.026 | ICD10CM | Covered |
| L89.106 | ICD10CM | Covered |
| L89.110 | ICD10CM | Covered |
| L89.111 | ICD10CM | Covered |
| L89.112 | ICD10CM | Covered |
| L89.113 | ICD10CM | Covered |
| L89.114 | ICD10CM | Covered |
| L89.116 | ICD10CM | Covered |
| L89.120 | ICD10CM | Covered |
| L89.121 | ICD10CM | Covered |
| L89.122 | ICD10CM | Covered |
| L89.123 | ICD10CM | Covered |
| L89.124 | ICD10CM | Covered |
| L89.126 | ICD10CM | Covered |
| L89.130 | ICD10CM | Covered |
| L89.131 | ICD10CM | Covered |
| L89.132 | ICD10CM | Covered |
| L89.133 | ICD10CM | Covered |
| L89.134 | ICD10CM | Covered |
| L89.136 | ICD10CM | Covered |
| L89.140 | ICD10CM | Covered |
| L89.141 | ICD10CM | Covered |
| L89.142 | ICD10CM | Covered |
| L89.143 | ICD10CM | Covered |
| L89.144 | ICD10CM | Covered |
| L89.146 | ICD10CM | Covered |
| L89.150 | ICD10CM | Covered |
| L89.151 | ICD10CM | Covered |
| L89.152 | ICD10CM | Covered |
| L89.153 | ICD10CM | Covered |
| L89.154 | ICD10CM | Covered |
| L89.156 | ICD10CM | Covered |
| L89.206 | ICD10CM | Covered |
| L89.210 | ICD10CM | Covered |
| L89.211 | ICD10CM | Covered |
| L89.212 | ICD10CM | Covered |
| L89.213 | ICD10CM | Covered |
| L89.214 | ICD10CM | Covered |
| L89.216 | ICD10CM | Covered |
| L89.220 | ICD10CM | Covered |
| L89.221 | ICD10CM | Covered |
| L89.222 | ICD10CM | Covered |
| L89.223 | ICD10CM | Covered |
| L89.224 | ICD10CM | Covered |
| L89.226 | ICD10CM | Covered |
| L89.306 | ICD10CM | Covered |
| L89.310 | ICD10CM | Covered |
| L89.311 | ICD10CM | Covered |
| L89.312 | ICD10CM | Covered |
| L89.313 | ICD10CM | Covered |
| L89.314 | ICD10CM | Covered |
| L89.316 | ICD10CM | Covered |
| L89.320 | ICD10CM | Covered |
| L89.321 | ICD10CM | Covered |
| L89.322 | ICD10CM | Covered |
| L89.323 | ICD10CM | Covered |
| L89.324 | ICD10CM | Covered |
| L89.326 | ICD10CM | Covered |
| L89.41 | ICD10CM | Covered |
| L89.42 | ICD10CM | Covered |
| L89.43 | ICD10CM | Covered |
| L89.44 | ICD10CM | Covered |
| L89.45 | ICD10CM | Covered |
| L89.46 | ICD10CM | Covered |
| L89.506 | ICD10CM | Covered |
| L89.510 | ICD10CM | Covered |
| L89.511 | ICD10CM | Covered |
| L89.512 | ICD10CM | Covered |
| L89.513 | ICD10CM | Covered |
| L89.514 | ICD10CM | Covered |
| L89.516 | ICD10CM | Covered |
| L89.520 | ICD10CM | Covered |
| L89.521 | ICD10CM | Covered |
| L89.522 | ICD10CM | Covered |
| L89.523 | ICD10CM | Covered |
| L89.524 | ICD10CM | Covered |
| L89.526 | ICD10CM | Covered |
| L89.606 | ICD10CM | Covered |
| L89.610 | ICD10CM | Covered |
| L89.611 | ICD10CM | Covered |
| L89.612 | ICD10CM | Covered |
| L89.613 | ICD10CM | Covered |
| L89.614 | ICD10CM | Covered |
| L89.616 | ICD10CM | Covered |
| L89.620 | ICD10CM | Covered |
| L89.621 | ICD10CM | Covered |
| L89.622 | ICD10CM | Covered |
| L89.623 | ICD10CM | Covered |
| L89.624 | ICD10CM | Covered |
| L89.626 | ICD10CM | Covered |
| L89.810 | ICD10CM | Covered |
| L89.811 | ICD10CM | Covered |
| L89.812 | ICD10CM | Covered |
| L89.813 | ICD10CM | Covered |
| L89.814 | ICD10CM | Covered |
| L89.816 | ICD10CM | Covered |
| L89.890 | ICD10CM | Covered |
| L89.891 | ICD10CM | Covered |
| L89.892 | ICD10CM | Covered |
| L89.893 | ICD10CM | Covered |
| L89.894 | ICD10CM | Covered |
| L89.896 | ICD10CM | Covered |
| L90.5 | ICD10CM | Covered |
| L97.112 | ICD10CM | Covered |
| L97.113 | ICD10CM | Covered |
| L97.114 | ICD10CM | Covered |
| L97.115 | ICD10CM | Covered |
| L97.116 | ICD10CM | Covered |
| L97.118 | ICD10CM | Covered |
| L97.122 | ICD10CM | Covered |
| L97.123 | ICD10CM | Covered |
| L97.124 | ICD10CM | Covered |
| L97.125 | ICD10CM | Covered |
| L97.126 | ICD10CM | Covered |
| L97.128 | ICD10CM | Covered |
| L97.212 | ICD10CM | Covered |
| L97.213 | ICD10CM | Covered |
| L97.214 | ICD10CM | Covered |
| L97.215 | ICD10CM | Covered |
| L97.216 | ICD10CM | Covered |
| L97.218 | ICD10CM | Covered |
| L97.222 | ICD10CM | Covered |
| L97.223 | ICD10CM | Covered |
| L97.224 | ICD10CM | Covered |
| L97.225 | ICD10CM | Covered |
| L97.226 | ICD10CM | Covered |
| L97.228 | ICD10CM | Covered |
| L97.229 | ICD10CM | Covered |
| L97.312 | ICD10CM | Covered |
| L97.313 | ICD10CM | Covered |
| L97.314 | ICD10CM | Covered |
| L97.315 | ICD10CM | Covered |
| L97.316 | ICD10CM | Covered |
| L97.318 | ICD10CM | Covered |
| L97.322 | ICD10CM | Covered |
| L97.323 | ICD10CM | Covered |
| L97.324 | ICD10CM | Covered |
| L97.325 | ICD10CM | Covered |
| L97.326 | ICD10CM | Covered |
| L97.328 | ICD10CM | Covered |
| L97.412 | ICD10CM | Covered |
| L97.413 | ICD10CM | Covered |
| L97.414 | ICD10CM | Covered |
| L97.415 | ICD10CM | Covered |
| L97.416 | ICD10CM | Covered |
| L97.418 | ICD10CM | Covered |
| L97.422 | ICD10CM | Covered |
| L97.423 | ICD10CM | Covered |
| L97.424 | ICD10CM | Covered |
| L97.425 | ICD10CM | Covered |
| L97.426 | ICD10CM | Covered |
| L97.428 | ICD10CM | Covered |
| L97.512 | ICD10CM | Covered |
| L97.513 | ICD10CM | Covered |
| L97.514 | ICD10CM | Covered |
| L97.515 | ICD10CM | Covered |
| L97.516 | ICD10CM | Covered |
| L97.518 | ICD10CM | Covered |
| L97.522 | ICD10CM | Covered |
| L97.523 | ICD10CM | Covered |
| L97.524 | ICD10CM | Covered |
| L97.525 | ICD10CM | Covered |
| L97.526 | ICD10CM | Covered |
| L97.528 | ICD10CM | Covered |
| L97.812 | ICD10CM | Covered |
| L97.813 | ICD10CM | Covered |
| L97.814 | ICD10CM | Covered |
| L97.815 | ICD10CM | Covered |
| L97.816 | ICD10CM | Covered |
| L97.818 | ICD10CM | Covered |
| L97.822 | ICD10CM | Covered |
| L97.823 | ICD10CM | Covered |
| L97.824 | ICD10CM | Covered |
| L97.825 | ICD10CM | Covered |
| L97.826 | ICD10CM | Covered |
| L97.828 | ICD10CM | Covered |
| L97.915 | ICD10CM | Covered |
| L97.916 | ICD10CM | Covered |
| L97.918 | ICD10CM | Covered |
| L97.925 | ICD10CM | Covered |
| L97.926 | ICD10CM | Covered |
| L97.928 | ICD10CM | Covered |
| L98.412 | ICD10CM | Covered |
| L98.413 | ICD10CM | Covered |
| L98.414 | ICD10CM | Covered |
| L98.415 | ICD10CM | Covered |
| L98.416 | ICD10CM | Covered |
| L98.418 | ICD10CM | Covered |
| L98.422 | ICD10CM | Covered |
| L98.423 | ICD10CM | Covered |
| L98.424 | ICD10CM | Covered |
| L98.425 | ICD10CM | Covered |
| L98.426 | ICD10CM | Covered |
| L98.428 | ICD10CM | Covered |
| L98.431 | ICD10CM | Covered |
| L98.432 | ICD10CM | Covered |
| L98.433 | ICD10CM | Covered |
| L98.434 | ICD10CM | Covered |
| L98.435 | ICD10CM | Covered |
| L98.436 | ICD10CM | Covered |
| L98.438 | ICD10CM | Covered |
| L98.439 | ICD10CM | Covered |
| L98.441 | ICD10CM | Covered |
| L98.442 | ICD10CM | Covered |
| L98.443 | ICD10CM | Covered |
| L98.444 | ICD10CM | Covered |
| L98.445 | ICD10CM | Covered |
| L98.446 | ICD10CM | Covered |
| L98.448 | ICD10CM | Covered |
| L98.449 | ICD10CM | Covered |
| L98.451 | ICD10CM | Covered |
| L98.452 | ICD10CM | Covered |
| L98.453 | ICD10CM | Covered |
| L98.454 | ICD10CM | Covered |
| L98.455 | ICD10CM | Covered |
| L98.456 | ICD10CM | Covered |
| L98.458 | ICD10CM | Covered |
| L98.459 | ICD10CM | Covered |
| L98.461 | ICD10CM | Covered |
| L98.462 | ICD10CM | Covered |
| L98.463 | ICD10CM | Covered |
| L98.464 | ICD10CM | Covered |
| L98.465 | ICD10CM | Covered |
| L98.466 | ICD10CM | Covered |
| L98.468 | ICD10CM | Covered |
| L98.469 | ICD10CM | Covered |
| L98.471 | ICD10CM | Covered |
| L98.472 | ICD10CM | Covered |
| L98.473 | ICD10CM | Covered |
| L98.474 | ICD10CM | Covered |
| L98.475 | ICD10CM | Covered |
| L98.476 | ICD10CM | Covered |
| L98.478 | ICD10CM | Covered |
| L98.479 | ICD10CM | Covered |
| L98.492 | ICD10CM | Covered |
| L98.493 | ICD10CM | Covered |
| L98.494 | ICD10CM | Covered |
| L98.495 | ICD10CM | Covered |
| L98.496 | ICD10CM | Covered |
| L98.498 | ICD10CM | Covered |
| L98.A111 | ICD10CM | Covered |
| L98.A112 | ICD10CM | Covered |
| L98.A113 | ICD10CM | Covered |
| L98.A114 | ICD10CM | Covered |
| L98.A115 | ICD10CM | Covered |
| L98.A116 | ICD10CM | Covered |
| L98.A118 | ICD10CM | Covered |
| L98.A119 | ICD10CM | Covered |
| L98.A121 | ICD10CM | Covered |
| L98.A122 | ICD10CM | Covered |
| L98.A123 | ICD10CM | Covered |
| L98.A124 | ICD10CM | Covered |
| L98.A125 | ICD10CM | Covered |
| L98.A126 | ICD10CM | Covered |
| L98.A128 | ICD10CM | Covered |
| L98.A129 | ICD10CM | Covered |
| L98.A191 | ICD10CM | Covered |
| L98.A192 | ICD10CM | Covered |
| L98.A193 | ICD10CM | Covered |
| L98.A194 | ICD10CM | Covered |
| L98.A195 | ICD10CM | Covered |
| L98.A196 | ICD10CM | Covered |
| L98.A198 | ICD10CM | Covered |
| L98.A199 | ICD10CM | Covered |
| L98.A211 | ICD10CM | Covered |
| L98.A212 | ICD10CM | Covered |
| L98.A213 | ICD10CM | Covered |
| L98.A214 | ICD10CM | Covered |
| L98.A215 | ICD10CM | Covered |
| L98.A216 | ICD10CM | Covered |
| L98.A218 | ICD10CM | Covered |
| L98.A219 | ICD10CM | Covered |
| L98.A221 | ICD10CM | Covered |
| L98.A222 | ICD10CM | Covered |
| L98.A223 | ICD10CM | Covered |
| L98.A224 | ICD10CM | Covered |
| L98.A225 | ICD10CM | Covered |
| L98.A226 | ICD10CM | Covered |
| L98.A228 | ICD10CM | Covered |
| L98.A229 | ICD10CM | Covered |
| L98.A291 | ICD10CM | Covered |
| L98.A292 | ICD10CM | Covered |
| L98.A293 | ICD10CM | Covered |
| L98.A294 | ICD10CM | Covered |
| L98.A295 | ICD10CM | Covered |
| L98.A296 | ICD10CM | Covered |
| L98.A298 | ICD10CM | Covered |
| L98.A299 | ICD10CM | Covered |
| L98.A311 | ICD10CM | Covered |
| L98.A312 | ICD10CM | Covered |
| L98.A313 | ICD10CM | Covered |
| L98.A314 | ICD10CM | Covered |
| L98.A315 | ICD10CM | Covered |
| L98.A316 | ICD10CM | Covered |
| L98.A318 | ICD10CM | Covered |
| L98.A319 | ICD10CM | Covered |
| L98.A321 | ICD10CM | Covered |
| L98.A322 | ICD10CM | Covered |
| L98.A323 | ICD10CM | Covered |
| L98.A324 | ICD10CM | Covered |
| L98.A325 | ICD10CM | Covered |
| L98.A326 | ICD10CM | Covered |
| L98.A328 | ICD10CM | Covered |
| L98.A329 | ICD10CM | Covered |
| L98.A391 | ICD10CM | Covered |
| L98.A392 | ICD10CM | Covered |
| L98.A393 | ICD10CM | Covered |
| L98.A394 | ICD10CM | Covered |
| L98.A395 | ICD10CM | Covered |
| L98.A396 | ICD10CM | Covered |
| L98.A398 | ICD10CM | Covered |
| L98.A399 | ICD10CM | Covered |
| M05.011 | ICD10CM | Covered |
| M05.012 | ICD10CM | Covered |
| M05.021 | ICD10CM | Covered |
| M05.022 | ICD10CM | Covered |
| M05.031 | ICD10CM | Covered |
| M05.032 | ICD10CM | Covered |
| M05.041 | ICD10CM | Covered |
| M05.042 | ICD10CM | Covered |
| M05.051 | ICD10CM | Covered |
| M05.052 | ICD10CM | Covered |
| M05.061 | ICD10CM | Covered |
| M05.062 | ICD10CM | Covered |
| M05.071 | ICD10CM | Covered |
| M05.072 | ICD10CM | Covered |
| M05.09 | ICD10CM | Covered |
| M05.111 | ICD10CM | Covered |
| M05.112 | ICD10CM | Covered |
| M05.121 | ICD10CM | Covered |
| M05.122 | ICD10CM | Covered |
| M05.131 | ICD10CM | Covered |
| M05.132 | ICD10CM | Covered |
| M05.141 | ICD10CM | Covered |
| M05.142 | ICD10CM | Covered |
| M05.151 | ICD10CM | Covered |
| M05.152 | ICD10CM | Covered |
| M05.161 | ICD10CM | Covered |
| M05.162 | ICD10CM | Covered |
| M05.171 | ICD10CM | Covered |
| M05.172 | ICD10CM | Covered |
| M05.19 | ICD10CM | Covered |
| M05.211 | ICD10CM | Covered |
| M05.212 | ICD10CM | Covered |
| M05.221 | ICD10CM | Covered |
| M05.222 | ICD10CM | Covered |
| M05.231 | ICD10CM | Covered |
| M05.232 | ICD10CM | Covered |
| M05.241 | ICD10CM | Covered |
| M05.242 | ICD10CM | Covered |
| M05.251 | ICD10CM | Covered |
| M05.252 | ICD10CM | Covered |
| M05.261 | ICD10CM | Covered |
| M05.262 | ICD10CM | Covered |
| M05.271 | ICD10CM | Covered |
| M05.272 | ICD10CM | Covered |
| M05.29 | ICD10CM | Covered |
| M05.311 | ICD10CM | Covered |
| M05.312 | ICD10CM | Covered |
| M05.321 | ICD10CM | Covered |
| M05.322 | ICD10CM | Covered |
| M05.331 | ICD10CM | Covered |
| M05.332 | ICD10CM | Covered |
| M05.341 | ICD10CM | Covered |
| M05.342 | ICD10CM | Covered |
| M05.351 | ICD10CM | Covered |
| M05.352 | ICD10CM | Covered |
| M05.361 | ICD10CM | Covered |
| M05.362 | ICD10CM | Covered |
| M05.371 | ICD10CM | Covered |
| M05.372 | ICD10CM | Covered |
| M05.39 | ICD10CM | Covered |
| M05.411 | ICD10CM | Covered |
| M05.412 | ICD10CM | Covered |
| M05.421 | ICD10CM | Covered |
| M05.422 | ICD10CM | Covered |
| M05.431 | ICD10CM | Covered |
| M05.432 | ICD10CM | Covered |
| M05.441 | ICD10CM | Covered |
| M05.442 | ICD10CM | Covered |
| M05.451 | ICD10CM | Covered |
| M05.452 | ICD10CM | Covered |
| M05.461 | ICD10CM | Covered |
| M05.462 | ICD10CM | Covered |
| M05.471 | ICD10CM | Covered |
| M05.472 | ICD10CM | Covered |
| M05.49 | ICD10CM | Covered |
| M05.511 | ICD10CM | Covered |
| M05.512 | ICD10CM | Covered |
| M05.521 | ICD10CM | Covered |
| M05.522 | ICD10CM | Covered |