Documentation requirements
Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, §3.4.1.3 Diagnosis Code Requirements
The CPT®/HCPCS codes included in this article will be subjected to "procedure to diagnosis" editing. The following lists include only those diagnoses for which the identified CPT®/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
At least 1 of the secondary diagnoses from Group 2 is required for *R13.X range of codes.
I69.091, I69.191, I69.291, I69.391, I69.891, I69.991, J69.0 and the "T" codes listed in Group 1 do not require a secondary diagnosis.
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 |
|---|---|---|
| 70370 | HCPCS | Covered |
| 70371 | HCPCS | Covered |
| 74230 | HCPCS | Covered |
| B91 | ICD10CM | Covered |
| C01 | ICD10CM | Covered |
| C02.0 | ICD10CM | Covered |
| C02.1 | ICD10CM | Covered |
| C02.2 | ICD10CM | Covered |
| C02.3 | ICD10CM | Covered |
| C02.4 | ICD10CM | Covered |
| C02.8 | ICD10CM | Covered |
| C02.9 | ICD10CM | Covered |
| C04.1 | ICD10CM | Covered |
| C04.8 | ICD10CM | Covered |