About this policy
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Infliximab L35677.
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.
| Code | Code system | Status in this policy |
|---|---|---|
| J1745 | HCPCS | Covered |
| Q5103 | HCPCS | Covered |
| Q5104 | HCPCS | Covered |
| Q5121 | HCPCS | Covered |
| D86.0 | ICD10CM | Covered |
| D86.1 | ICD10CM | Covered |
| D86.2 | ICD10CM | Covered |
| D86.3 | ICD10CM | Covered |
| D86.81 | ICD10CM | Covered |
| D86.82 | ICD10CM | Covered |
| D86.83 | ICD10CM | Covered |
| D86.84 | ICD10CM | Covered |
| D86.85 | ICD10CM | Covered |
| D86.86 | ICD10CM | Covered |
| D86.87 | ICD10CM | Covered |
| D86.89 | ICD10CM | Covered |
| D86.9 | ICD10CM | Covered |
| H44.111 | ICD10CM | Covered |
| H44.112 | ICD10CM | Covered |
| H44.113 | ICD10CM | Covered |
| H44.119 | ICD10CM | Covered |
| I30.8 | ICD10CM | Covered |
| I30.9 | ICD10CM | Covered |
| I40.8 | ICD10CM | Covered |
| I40.9 | ICD10CM | Covered |
| J70.2 | ICD10CM | Covered |
| J70.4 | ICD10CM | Covered |
| K50.00 | ICD10CM | Covered |
| K50.011 | ICD10CM | Covered |
| K50.012 | ICD10CM | Covered |
| K50.013 | ICD10CM | Covered |
| K50.014 | ICD10CM | Covered |
| K50.018 | ICD10CM | Covered |
| K50.019 | ICD10CM | Covered |
| K50.10 | ICD10CM | Covered |
| K50.111 | ICD10CM | Covered |
| K50.112 | ICD10CM | Covered |
| K50.113 | ICD10CM | Covered |
| K50.114 | ICD10CM | Covered |
| K50.118 | ICD10CM | Covered |
| K50.119 | ICD10CM | Covered |
| K50.80 | ICD10CM | Covered |
| K50.811 | ICD10CM | Covered |
| K50.812 | ICD10CM | Covered |
| K50.813 | ICD10CM | Covered |
| K50.814 | ICD10CM | Covered |
| K50.818 | ICD10CM | Covered |
| K50.819 | ICD10CM | Covered |
| K50.90 | ICD10CM | Covered |
| K50.911 | ICD10CM | Covered |
| K50.912 | ICD10CM | Covered |
| K50.913 | ICD10CM | Covered |
| K50.914 | ICD10CM | Covered |
| K50.918 | ICD10CM | Covered |
| K50.919 | ICD10CM | Covered |
| K51.00 | ICD10CM | Covered |
| K51.011 | ICD10CM | Covered |
| K51.012 | ICD10CM | Covered |
| K51.013 | ICD10CM | Covered |
| K51.014 | ICD10CM | Covered |
| K51.018 | ICD10CM | Covered |
| K51.019 | ICD10CM | Covered |
| K51.20 | ICD10CM | Covered |
| K51.211 | ICD10CM | Covered |
| K51.212 | ICD10CM | Covered |
| K51.213 | ICD10CM | Covered |
| K51.214 | ICD10CM | Covered |
| K51.218 | ICD10CM | Covered |
| K51.219 | ICD10CM | Covered |
| K51.30 | ICD10CM | Covered |
| K51.311 | ICD10CM | Covered |
| K51.312 | ICD10CM | Covered |
| K51.313 | ICD10CM | Covered |
| K51.314 | ICD10CM | Covered |
| K51.318 | ICD10CM | Covered |
| K51.319 | ICD10CM | Covered |
| K51.50 | ICD10CM | Covered |
| K51.511 | ICD10CM | Covered |
| K51.512 | ICD10CM | Covered |
| K51.513 | ICD10CM | Covered |
| K51.514 | ICD10CM | Covered |
| K51.518 | ICD10CM | Covered |
| K51.519 | ICD10CM | Covered |
| K51.80 | ICD10CM | Covered |
| K51.811 | ICD10CM | Covered |
| K51.812 | ICD10CM | Covered |
| K51.813 | ICD10CM | Covered |
| K51.814 | ICD10CM | Covered |
| K51.818 | ICD10CM | Covered |
| K51.819 | ICD10CM | Covered |
| K51.90 | ICD10CM | Covered |
| K51.911 | ICD10CM | Covered |
| K51.912 | ICD10CM | Covered |
| K51.913 | ICD10CM | Covered |
| K51.914 | ICD10CM | Covered |
| K51.918 | ICD10CM | Covered |
| K51.919 | ICD10CM | Covered |
| K52.1 | ICD10CM | Covered |
| K63.2 | ICD10CM | Covered |
| L40.0 | ICD10CM | Covered |
| L40.1 | ICD10CM | Covered |
| L40.2 | ICD10CM | Covered |
| L40.3 | ICD10CM | Covered |
| L40.4 | ICD10CM | Covered |
| L40.50 | ICD10CM | Covered |
| L40.51 | ICD10CM | Covered |
| L40.52 | ICD10CM | Covered |
| L40.53 | ICD10CM | Covered |
| L40.54 | ICD10CM | Covered |
| L40.59 | ICD10CM | Covered |
| L40.8 | ICD10CM | Covered |
| L40.9 | ICD10CM | Covered |
| L73.2 | ICD10CM | Covered |
| M02.30 | ICD10CM | Covered |
| M02.311 | ICD10CM | Covered |
| M02.312 | ICD10CM | Covered |
| M02.319 | ICD10CM | Covered |
| M02.321 | ICD10CM | Covered |
| M02.322 | ICD10CM | Covered |
| M02.329 | ICD10CM | Covered |
| M02.331 | ICD10CM | Covered |
| M02.332 | ICD10CM | Covered |
| M02.339 | ICD10CM | Covered |
| M02.341 | ICD10CM | Covered |
| M02.342 | ICD10CM | Covered |
| M02.349 | ICD10CM | Covered |
| M02.351 | ICD10CM | Covered |
| M02.352 | ICD10CM | Covered |
| M02.359 | ICD10CM | Covered |
| M02.361 | ICD10CM | Covered |
| M02.362 | ICD10CM | Covered |
| M02.369 | ICD10CM | Covered |
| M02.371 | ICD10CM | Covered |
| M02.372 | ICD10CM | Covered |
| M02.379 | ICD10CM | Covered |
| M02.38 | ICD10CM | Covered |
| M02.39 | ICD10CM | Covered |
| M02.80 | ICD10CM | Covered |
| M02.811 | ICD10CM | Covered |
| M02.812 | ICD10CM | Covered |
| M02.819 | ICD10CM | Covered |
| M02.831 | ICD10CM | Covered |
| M02.832 | ICD10CM | Covered |
| M02.839 | ICD10CM | Covered |
| M02.841 | ICD10CM | Covered |
| M02.842 | ICD10CM | Covered |
| M02.849 | ICD10CM | Covered |
| M02.851 | ICD10CM | Covered |
| M02.852 | ICD10CM | Covered |
| M02.859 | ICD10CM | Covered |
| M02.861 | ICD10CM | Covered |
| M02.862 | ICD10CM | Covered |
| M02.869 | ICD10CM | Covered |
| M02.871 | ICD10CM | Covered |
| M02.872 | ICD10CM | Covered |
| M02.879 | ICD10CM | Covered |
| M02.88 | ICD10CM | Covered |
| M02.89 | ICD10CM | Covered |
| M02.9 | ICD10CM | Covered |
| M05.20 | ICD10CM | Covered |
| M05.211 | ICD10CM | Covered |
| M05.212 | ICD10CM | Covered |
| M05.219 | ICD10CM | Covered |
| M05.221 | ICD10CM | Covered |
| M05.222 | ICD10CM | Covered |
| M05.229 | ICD10CM | Covered |
| M05.231 | ICD10CM | Covered |
| M05.232 | ICD10CM | Covered |
| M05.239 | ICD10CM | Covered |
| M05.241 | ICD10CM | Covered |
| M05.242 | ICD10CM | Covered |
| M05.249 | ICD10CM | Covered |
| M05.251 | ICD10CM | Covered |
| M05.252 | ICD10CM | Covered |
| M05.259 | ICD10CM | Covered |
| M05.261 | ICD10CM | Covered |
| M05.262 | ICD10CM | Covered |
| M05.269 | ICD10CM | Covered |
| M05.271 | ICD10CM | Covered |
| M05.272 | ICD10CM | Covered |
| M05.279 | ICD10CM | Covered |
| M05.29 | ICD10CM | Covered |
| M05.30 | ICD10CM | Covered |
| M05.311 | ICD10CM | Covered |
| M05.312 | ICD10CM | Covered |
| M05.319 | ICD10CM | Covered |
| M05.321 | ICD10CM | Covered |
| M05.322 | ICD10CM | Covered |
| M05.329 | ICD10CM | Covered |
| M05.331 | ICD10CM | Covered |
| M05.332 | ICD10CM | Covered |
| M05.339 | ICD10CM | Covered |
| M05.341 | ICD10CM | Covered |
| M05.342 | ICD10CM | Covered |
| M05.349 | ICD10CM | Covered |
| M05.351 | ICD10CM | Covered |
| M05.352 | ICD10CM | Covered |
| M05.359 | ICD10CM | Covered |
| M05.361 | ICD10CM | Covered |
| M05.362 | ICD10CM | Covered |
| M05.369 | ICD10CM | Covered |
| M05.371 | ICD10CM | Covered |
| M05.372 | ICD10CM | Covered |
| M05.379 | ICD10CM | Covered |
| M05.39 | ICD10CM | Covered |
| M05.40 | ICD10CM | Covered |
| M05.411 | ICD10CM | Covered |
| M05.412 | ICD10CM | Covered |
| M05.419 | ICD10CM | Covered |
| M05.421 | ICD10CM | Covered |
| M05.422 | ICD10CM | Covered |
| M05.429 | ICD10CM | Covered |
| M05.431 | ICD10CM | Covered |
| M05.432 | ICD10CM | Covered |
| M05.439 | ICD10CM | Covered |
| M05.441 | ICD10CM | Covered |
| M05.442 | ICD10CM | Covered |
| M05.449 | ICD10CM | Covered |
| M05.451 | ICD10CM | Covered |
| M05.452 | ICD10CM | Covered |
| M05.459 | ICD10CM | Covered |
| M05.461 | ICD10CM | Covered |
| M05.462 | ICD10CM | Covered |
| M05.469 | ICD10CM | Covered |
| M05.471 | ICD10CM | Covered |
| M05.472 | ICD10CM | Covered |
| M05.479 | ICD10CM | Covered |
| M05.49 | ICD10CM | Covered |
| M05.50 | ICD10CM | Covered |
| M05.511 | ICD10CM | Covered |
| M05.512 | ICD10CM | Covered |
| M05.519 | ICD10CM | Covered |
| M05.521 | ICD10CM | Covered |
| M05.522 | ICD10CM | Covered |
| M05.529 | ICD10CM | Covered |
| M05.531 | ICD10CM | Covered |
| M05.532 | ICD10CM | Covered |
| M05.539 | ICD10CM | Covered |
| M05.541 | ICD10CM | Covered |
| M05.542 | ICD10CM | Covered |
| M05.549 | ICD10CM | Covered |
| M05.551 | ICD10CM | Covered |
| M05.552 | ICD10CM | Covered |
| M05.559 | ICD10CM | Covered |
| M05.561 | ICD10CM | Covered |
| M05.562 | ICD10CM | Covered |
| M05.569 | ICD10CM | Covered |
| M05.571 | ICD10CM | Covered |
| M05.572 | ICD10CM | Covered |
| M05.579 | ICD10CM | Covered |
| M05.59 | ICD10CM | Covered |
| M05.60 | ICD10CM | Covered |
| M05.611 | ICD10CM | Covered |
| M05.612 | ICD10CM | Covered |
| M05.619 | ICD10CM | Covered |
| M05.621 | ICD10CM | Covered |
| M05.622 | ICD10CM | Covered |
| M05.629 | ICD10CM | Covered |
| M05.631 | ICD10CM | Covered |
| M05.632 | ICD10CM | Covered |
| M05.639 | ICD10CM | Covered |
| M05.641 | ICD10CM | Covered |
| M05.642 | ICD10CM | Covered |
| M05.649 | ICD10CM | Covered |
| M05.651 | ICD10CM | Covered |
| M05.652 | ICD10CM | Covered |
| M05.659 | ICD10CM | Covered |
| M05.661 | ICD10CM | Covered |
| M05.662 | ICD10CM | Covered |
| M05.669 | ICD10CM | Covered |
| M05.671 | ICD10CM | Covered |
| M05.672 | ICD10CM | Covered |
| M05.679 | ICD10CM | Covered |
| M05.69 | ICD10CM | Covered |
| M05.70 | ICD10CM | Covered |
| M05.711 | ICD10CM | Covered |
| M05.712 | ICD10CM | Covered |
| M05.719 | ICD10CM | Covered |
| M05.721 | ICD10CM | Covered |
| M05.722 | ICD10CM | Covered |
| M05.729 | ICD10CM | Covered |
| M05.731 | ICD10CM | Covered |
| M05.732 | ICD10CM | Covered |
| M05.739 | ICD10CM | Covered |
| M05.741 | ICD10CM | Covered |
| M05.742 | ICD10CM | Covered |
| M05.749 | ICD10CM | Covered |
| M05.751 | ICD10CM | Covered |
| M05.752 | ICD10CM | Covered |
| M05.759 | ICD10CM | Covered |
| M05.761 | ICD10CM | Covered |
| M05.762 | ICD10CM | Covered |
| M05.769 | ICD10CM | Covered |
| M05.771 | ICD10CM | Covered |
| M05.772 | ICD10CM | Covered |
| M05.779 | ICD10CM | Covered |
| M05.79 | ICD10CM | Covered |
| M05.80 | ICD10CM | Covered |
| M05.811 | ICD10CM | Covered |
| M05.812 | ICD10CM | Covered |
| M05.819 | ICD10CM | Covered |
| M05.821 | ICD10CM | Covered |
| M05.822 | ICD10CM | Covered |
| M05.829 | ICD10CM | Covered |
| M05.831 | ICD10CM | Covered |
| M05.832 | ICD10CM | Covered |
| M05.839 | ICD10CM | Covered |
| M05.841 | ICD10CM | Covered |
| M05.842 | ICD10CM | Covered |
| M05.849 | ICD10CM | Covered |
| M05.851 | ICD10CM | Covered |
| M05.852 | ICD10CM | Covered |
| M05.859 | ICD10CM | Covered |
| M05.861 | ICD10CM | Covered |
| M05.862 | ICD10CM | Covered |
| M05.869 | ICD10CM | Covered |
| M05.871 | ICD10CM | Covered |
| M05.872 | ICD10CM | Covered |
| M05.879 | ICD10CM | Covered |
| M05.89 | ICD10CM | Covered |
| M05.8A | ICD10CM | Covered |
| M05.9 | ICD10CM | Covered |
| M05.A | ICD10CM | Covered |
| M06.00 | ICD10CM | Covered |
| M06.011 | ICD10CM | Covered |
| M06.012 | ICD10CM | Covered |
| M06.019 | ICD10CM | Covered |
| M06.021 | ICD10CM | Covered |
| M06.022 | ICD10CM | Covered |
| M06.029 | ICD10CM | Covered |
| M06.031 | ICD10CM | Covered |
| M06.032 | ICD10CM | Covered |
| M06.039 | ICD10CM | Covered |
| M06.041 | ICD10CM | Covered |
| M06.042 | ICD10CM | Covered |
| M06.049 | ICD10CM | Covered |
| M06.051 | ICD10CM | Covered |
| M06.052 | ICD10CM | Covered |
| M06.059 | ICD10CM | Covered |
| M06.061 | ICD10CM | Covered |
| M06.062 | ICD10CM | Covered |
| M06.069 | ICD10CM | Covered |
| M06.071 | ICD10CM | Covered |
| M06.072 | ICD10CM | Covered |
| M06.079 | ICD10CM | Covered |
| M06.08 | ICD10CM | Covered |
| M06.09 | ICD10CM | Covered |
| M06.0A | ICD10CM | Covered |
| M06.4 | ICD10CM | Covered |
| M06.9 | ICD10CM | Covered |
| M08.011 | ICD10CM | Covered |
| M08.012 | ICD10CM | Covered |
| M08.021 | ICD10CM | Covered |
| M08.022 | ICD10CM | Covered |
| M08.031 | ICD10CM | Covered |
| M08.032 | ICD10CM | Covered |
| M08.041 | ICD10CM | Covered |
| M08.042 | ICD10CM | Covered |
| M08.051 | ICD10CM | Covered |
| M08.052 | ICD10CM | Covered |
| M08.061 | ICD10CM | Covered |
| M08.062 | ICD10CM | Covered |
| M08.071 | ICD10CM | Covered |
| M08.072 | ICD10CM | Covered |
| M08.08 | ICD10CM | Covered |
| M08.09 | ICD10CM | Covered |
| M08.0A | ICD10CM | Covered |
| M08.1 | ICD10CM | Covered |
| M08.2A | ICD10CM | Covered |
| M08.3 | ICD10CM | Covered |
| M08.411 | ICD10CM | Covered |
| M08.412 | ICD10CM | Covered |
| M08.421 | ICD10CM | Covered |
| M08.422 | ICD10CM | Covered |
| M08.431 | ICD10CM | Covered |
| M08.432 | ICD10CM | Covered |
| M08.441 | ICD10CM | Covered |
| M08.442 | ICD10CM | Covered |
| M08.451 | ICD10CM | Covered |
| M08.452 | ICD10CM | Covered |
| M08.461 | ICD10CM | Covered |
| M08.462 | ICD10CM | Covered |
| M08.471 | ICD10CM | Covered |
| M08.472 | ICD10CM | Covered |
| M08.48 | ICD10CM | Covered |
| M08.9A | ICD10CM | Covered |
| M31.4 | ICD10CM | Covered |
| M35.2 | ICD10CM | Covered |
| M45.0 | ICD10CM | Covered |
| M45.1 | ICD10CM | Covered |
| M45.2 | ICD10CM | Covered |
| M45.3 | ICD10CM | Covered |
| M45.4 | ICD10CM | Covered |
| M45.5 | ICD10CM | Covered |
| M45.6 | ICD10CM | Covered |
| M45.7 | ICD10CM | Covered |
| M45.8 | ICD10CM | Covered |
| M45.9 | ICD10CM | Covered |
| M48.8X1 | ICD10CM | Covered |
| M48.8X2 | ICD10CM | Covered |
| M48.8X3 | ICD10CM | Covered |
| M48.8X4 | ICD10CM | Covered |
| M48.8X5 | ICD10CM | Covered |
| M48.8X6 | ICD10CM | Covered |
| M48.8X7 | ICD10CM | Covered |
| M48.8X8 | ICD10CM | Covered |
| M48.8X9 | ICD10CM | Covered |
| N17.8 | ICD10CM | Covered |
| N17.9 | ICD10CM | Covered |
| R19.7 | ICD10CM | Covered |