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 1,726 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 93303 | HCPCS | Covered |
| 93304 | HCPCS | Covered |
| 93306 | HCPCS | Covered |
| 93307 | HCPCS | Covered |
| 93308 | HCPCS | Covered |
| 93312 | HCPCS | Covered |
| 93313 | HCPCS | Covered |
| 93314 | HCPCS | Covered |
| 93315 | HCPCS | Covered |
| 93316 | HCPCS | Covered |
| 93317 | HCPCS | Covered |
| 93318 | HCPCS | Covered |
| 93319 | HCPCS | Covered |
| 93320 | HCPCS | Covered |
| 93321 | HCPCS | Covered |
| 93325 | HCPCS | Covered |
| 93350 | HCPCS | Covered |
| 93351 | HCPCS | Covered |
| 93352 | HCPCS | Covered |
| 93355 | HCPCS | Covered |
| A9700 | HCPCS | Covered |
| J0153 | HCPCS | Covered |
| J0280 | HCPCS | Covered |
| J0461 | HCPCS | Covered |
| J1245 | HCPCS | Covered |
| J1250 | HCPCS | Covered |
| A18.84 | ICD10CM | Covered |
| A40.0 | ICD10CM | Covered |
| A40.1 | ICD10CM | Covered |
| A40.3 | ICD10CM | Covered |
| A40.8 | ICD10CM | Covered |
| A40.9 | ICD10CM | Covered |
| A41.01 | ICD10CM | Covered |
| A41.02 | ICD10CM | Covered |
| A41.1 | ICD10CM | Covered |
| A41.2 | ICD10CM | Covered |
| A41.3 | ICD10CM | Covered |
| A41.4 | ICD10CM | Covered |
| A41.50 | ICD10CM | Covered |
| A41.51 | ICD10CM | Covered |
| A41.52 | ICD10CM | Covered |
| A41.53 | ICD10CM | Covered |
| A41.54 | ICD10CM | Covered |
| A41.59 | ICD10CM | Covered |
| A41.81 | ICD10CM | Covered |
| A41.89 | ICD10CM | Covered |
| A41.9 | ICD10CM | Covered |
| A42.7 | ICD10CM | Covered |
| A52.00 | ICD10CM | Covered |
| A52.01 | ICD10CM | Covered |
| A52.02 | ICD10CM | Covered |
| A52.03 | ICD10CM | Covered |
| A52.04 | ICD10CM | Covered |
| A52.05 | ICD10CM | Covered |
| A52.06 | ICD10CM | Covered |
| A52.09 | ICD10CM | Covered |
| A54.83 | ICD10CM | Covered |
| A69.20 | ICD10CM | Covered |
| A69.29 | ICD10CM | Covered |
| B33.20 | ICD10CM | Covered |
| B33.21 | ICD10CM | Covered |
| B33.22 | ICD10CM | Covered |
| B33.23 | ICD10CM | Covered |
| B37.6 | ICD10CM | Covered |
| B44.81 | ICD10CM | Covered |
| B57.0 | ICD10CM | Covered |
| B57.2 | ICD10CM | Covered |
| B58.81 | ICD10CM | Covered |
| C38.0 | ICD10CM | Covered |
| C38.8 | ICD10CM | Covered |
| C45.2 | ICD10CM | Covered |
| D15.1 | ICD10CM | Covered |
| D35.7 | ICD10CM | Covered |
| D86.85 | ICD10CM | Covered |
| D86.9 | ICD10CM | Covered |
| E10.10 | ICD10CM | Covered |
| E10.11 | ICD10CM | Covered |
| E10.21 | ICD10CM | Covered |
| E10.22 | ICD10CM | Covered |
| E10.29 | ICD10CM | Covered |
| E10.59 | ICD10CM | Covered |
| E10.641 | ICD10CM | Covered |
| E10.649 | ICD10CM | Covered |
| E10.65 | ICD10CM | Covered |
| E10.69 | ICD10CM | Covered |
| E10.8 | ICD10CM | Covered |
| E10.9 | ICD10CM | Covered |
| E11.00 | ICD10CM | Covered |
| E11.01 | ICD10CM | Covered |
| E11.10 | ICD10CM | Covered |
| E11.11 | ICD10CM | Covered |
| E11.21 | ICD10CM | Covered |
| E11.22 | ICD10CM | Covered |
| E11.29 | ICD10CM | Covered |
| E11.59 | ICD10CM | Covered |
| E11.641 | ICD10CM | Covered |
| E11.649 | ICD10CM | Covered |
| E11.65 | ICD10CM | Covered |
| E11.69 | ICD10CM | Covered |
| E11.8 | ICD10CM | Covered |
| E11.9 | ICD10CM | Covered |
| E13.00 | ICD10CM | Covered |
| E13.01 | ICD10CM | Covered |
| E13.10 | ICD10CM | Covered |
| E13.11 | ICD10CM | Covered |
| E13.21 | ICD10CM | Covered |
| E13.22 | ICD10CM | Covered |
| E13.29 | ICD10CM | Covered |
| E13.59 | ICD10CM | Covered |
| E13.641 | ICD10CM | Covered |
| E13.649 | ICD10CM | Covered |
| E13.65 | ICD10CM | Covered |
| E13.69 | ICD10CM | Covered |
| E13.8 | ICD10CM | Covered |
| E13.9 | ICD10CM | Covered |
| E83.110 | ICD10CM | Covered |
| E83.111 | ICD10CM | Covered |
| E83.118 | ICD10CM | Covered |
| E83.119 | ICD10CM | Covered |
| E83.19 | ICD10CM | Covered |
| E85.0 | ICD10CM | Covered |
| E85.1 | ICD10CM | Covered |
| E85.2 | ICD10CM | Covered |
| E85.3 | ICD10CM | Covered |
| E85.4 | ICD10CM | Covered |
| E85.81 | ICD10CM | Covered |
| E85.82 | ICD10CM | Covered |
| E85.89 | ICD10CM | Covered |
| E85.9 | ICD10CM | Covered |
| E86.0 | ICD10CM | Covered |
| E86.1 | ICD10CM | Covered |
| E86.9 | ICD10CM | Covered |
| E87.70 | ICD10CM | Covered |
| E87.71 | ICD10CM | Covered |
| E87.79 | ICD10CM | Covered |
| G45.1 | ICD10CM | Covered |
| G45.2 | ICD10CM | Covered |
| G45.3 | ICD10CM | Covered |
| G45.8 | ICD10CM | Covered |
| G45.9 | ICD10CM | Covered |
| G46.0 | ICD10CM | Covered |
| G46.1 | ICD10CM | Covered |
| G46.2 | ICD10CM | Covered |
| H34.01 | ICD10CM | Covered |
| H34.02 | ICD10CM | Covered |
| H34.03 | ICD10CM | Covered |
| H34.11 | ICD10CM | Covered |
| H34.12 | ICD10CM | Covered |
| H34.13 | ICD10CM | Covered |
| H34.211 | ICD10CM | Covered |
| H34.212 | ICD10CM | Covered |
| H34.213 | ICD10CM | Covered |
| H34.231 | ICD10CM | Covered |
| H34.232 | ICD10CM | Covered |
| H34.233 | ICD10CM | Covered |
| H34.821 | ICD10CM | Covered |
| H34.822 | ICD10CM | Covered |
| H34.823 | ICD10CM | Covered |
| H34.9 | ICD10CM | Covered |
| I01.0 | ICD10CM | Covered |
| I01.1 | ICD10CM | Covered |
| I01.2 | ICD10CM | Covered |
| I01.8 | ICD10CM | Covered |
| I01.9 | ICD10CM | Covered |
| I02.0 | ICD10CM | Covered |
| I05.0 | ICD10CM | Covered |
| I05.1 | ICD10CM | Covered |
| I05.2 | ICD10CM | Covered |
| I05.8 | ICD10CM | Covered |
| I05.9 | ICD10CM | Covered |
| I06.0 | ICD10CM | Covered |
| I06.1 | ICD10CM | Covered |
| I06.2 | ICD10CM | Covered |
| I06.8 | ICD10CM | Covered |
| I06.9 | ICD10CM | Covered |
| I07.0 | ICD10CM | Covered |
| I07.1 | ICD10CM | Covered |
| I07.2 | ICD10CM | Covered |
| I07.8 | ICD10CM | Covered |
| I07.9 | ICD10CM | Covered |
| I08.0 | ICD10CM | Covered |
| I08.1 | ICD10CM | Covered |
| I08.2 | ICD10CM | Covered |
| I08.3 | ICD10CM | Covered |
| I08.8 | ICD10CM | Covered |
| I08.9 | ICD10CM | Covered |
| I09.0 | ICD10CM | Covered |
| I09.1 | ICD10CM | Covered |
| I09.2 | ICD10CM | Covered |
| I09.81 | ICD10CM | Covered |
| I09.89 | ICD10CM | Covered |
| I09.9 | ICD10CM | Covered |
| I10 | ICD10CM | Covered |
| I11.0 | ICD10CM | Covered |
| I11.9 | ICD10CM | Covered |
| I12.0 | ICD10CM | Covered |
| I12.9 | ICD10CM | Covered |
| I13.0 | ICD10CM | Covered |
| I13.10 | ICD10CM | Covered |
| I13.11 | ICD10CM | Covered |
| I13.2 | ICD10CM | Covered |
| I15.0 | ICD10CM | Covered |
| I15.1 | ICD10CM | Covered |
| I15.2 | ICD10CM | Covered |
| I15.8 | ICD10CM | Covered |
| I15.9 | ICD10CM | Covered |
| I16.0 | ICD10CM | Covered |
| I16.1 | ICD10CM | Covered |
| I16.9 | ICD10CM | Covered |
| I20.0 | ICD10CM | Covered |
| I20.1 | ICD10CM | Covered |
| I20.81 | ICD10CM | Covered |
| I20.89 | ICD10CM | Covered |
| I20.9 | ICD10CM | Covered |
| I21.01 | ICD10CM | Covered |
| I21.02 | ICD10CM | Covered |
| I21.09 | ICD10CM | Covered |
| I21.11 | ICD10CM | Covered |
| I21.19 | ICD10CM | Covered |
| I21.21 | ICD10CM | Covered |
| I21.29 | ICD10CM | Covered |
| I21.4 | ICD10CM | Covered |
| I21.9 | ICD10CM | Covered |
| I21.A1 | ICD10CM | Covered |
| I21.A9 | ICD10CM | Covered |
| I21.B | ICD10CM | Covered |
| I22.0 | ICD10CM | Covered |
| I22.1 | ICD10CM | Covered |
| I22.2 | ICD10CM | Covered |
| I22.8 | ICD10CM | Covered |
| I23.0 | ICD10CM | Covered |
| I23.1 | ICD10CM | Covered |
| I23.2 | ICD10CM | Covered |
| I23.3 | ICD10CM | Covered |
| I23.4 | ICD10CM | Covered |
| I23.5 | ICD10CM | Covered |
| I23.6 | ICD10CM | Covered |
| I23.7 | ICD10CM | Covered |
| I23.8 | ICD10CM | Covered |
| I24.0 | ICD10CM | Covered |
| I24.1 | ICD10CM | Covered |
| I24.81 | ICD10CM | Covered |
| I24.89 | ICD10CM | Covered |
| I24.9 | ICD10CM | Covered |
| I25.10 | ICD10CM | Covered |
| I25.110 | ICD10CM | Covered |
| I25.111 | ICD10CM | Covered |
| I25.112 | ICD10CM | Covered |
| I25.118 | ICD10CM | Covered |
| I25.119 | ICD10CM | Covered |
| I25.2 | ICD10CM | Covered |
| I25.3 | ICD10CM | Covered |
| I25.41 | ICD10CM | Covered |
| I25.42 | ICD10CM | Covered |
| I25.5 | ICD10CM | Covered |
| I25.6 | ICD10CM | Covered |
| I25.700 | ICD10CM | Covered |
| I25.701 | ICD10CM | Covered |
| I25.702 | ICD10CM | Covered |
| I25.708 | ICD10CM | Covered |
| I25.709 | ICD10CM | Covered |
| I25.710 | ICD10CM | Covered |
| I25.711 | ICD10CM | Covered |
| I25.712 | ICD10CM | Covered |
| I25.718 | ICD10CM | Covered |
| I25.719 | ICD10CM | Covered |
| I25.720 | ICD10CM | Covered |
| I25.721 | ICD10CM | Covered |
| I25.722 | ICD10CM | Covered |
| I25.728 | ICD10CM | Covered |
| I25.729 | ICD10CM | Covered |
| I25.730 | ICD10CM | Covered |
| I25.731 | ICD10CM | Covered |
| I25.732 | ICD10CM | Covered |
| I25.738 | ICD10CM | Covered |
| I25.739 | ICD10CM | Covered |
| I25.750 | ICD10CM | Covered |
| I25.751 | ICD10CM | Covered |
| I25.752 | ICD10CM | Covered |
| I25.758 | ICD10CM | Covered |
| I25.759 | ICD10CM | Covered |
| I25.760 | ICD10CM | Covered |
| I25.761 | ICD10CM | Covered |
| I25.762 | ICD10CM | Covered |
| I25.768 | ICD10CM | Covered |
| I25.769 | ICD10CM | Covered |
| I25.790 | ICD10CM | Covered |
| I25.791 | ICD10CM | Covered |
| I25.792 | ICD10CM | Covered |
| I25.798 | ICD10CM | Covered |
| I25.799 | ICD10CM | Covered |
| I25.810 | ICD10CM | Covered |
| I25.811 | ICD10CM | Covered |
| I25.812 | ICD10CM | Covered |
| I25.82 | ICD10CM | Covered |
| I25.85 | ICD10CM | Covered |
| I25.89 | ICD10CM | Covered |
| I25.9 | ICD10CM | Covered |
| I26.01 | ICD10CM | Covered |
| I26.02 | ICD10CM | Covered |
| I26.03 | ICD10CM | Covered |
| I26.04 | ICD10CM | Covered |
| I26.09 | ICD10CM | Covered |
| I26.90 | ICD10CM | Covered |
| I26.92 | ICD10CM | Covered |
| I26.93 | ICD10CM | Covered |
| I26.94 | ICD10CM | Covered |
| I26.95 | ICD10CM | Covered |
| I26.96 | ICD10CM | Covered |
| I26.99 | ICD10CM | Covered |
| I27.0 | ICD10CM | Covered |
| I27.1 | ICD10CM | Covered |
| I27.20 | ICD10CM | Covered |
| I27.21 | ICD10CM | Covered |
| I27.22 | ICD10CM | Covered |
| I27.23 | ICD10CM | Covered |
| I27.24 | ICD10CM | Covered |
| I27.29 | ICD10CM | Covered |
| I27.81 | ICD10CM | Covered |
| I27.82 | ICD10CM | Covered |
| I27.83 | ICD10CM | Covered |
| I27.840 | ICD10CM | Covered |
| I27.841 | ICD10CM | Covered |
| I27.848 | ICD10CM | Covered |
| I27.849 | ICD10CM | Covered |
| I27.89 | ICD10CM | Covered |
| I27.9 | ICD10CM | Covered |
| I28.0 | ICD10CM | Covered |
| I28.1 | ICD10CM | Covered |
| I28.8 | ICD10CM | Covered |
| I28.9 | ICD10CM | Covered |
| I30.0 | ICD10CM | Covered |
| I30.1 | ICD10CM | Covered |
| I30.8 | ICD10CM | Covered |
| I30.9 | ICD10CM | Covered |
| I31.0 | ICD10CM | Covered |
| I31.1 | ICD10CM | Covered |
| I31.2 | ICD10CM | Covered |
| I31.31 | ICD10CM | Covered |
| I31.39 | ICD10CM | Covered |
| I31.4 | ICD10CM | Covered |
| I31.8 | ICD10CM | Covered |
| I31.9 | ICD10CM | Covered |
| I32 | ICD10CM | Covered |
| I33.0 | ICD10CM | Covered |
| I33.9 | ICD10CM | Covered |
| I34.0 | ICD10CM | Covered |
| I34.1 | ICD10CM | Covered |
| I34.2 | ICD10CM | Covered |
| I34.9 | ICD10CM | Covered |
| I35.0 | ICD10CM | Covered |
| I35.1 | ICD10CM | Covered |
| I35.2 | ICD10CM | Covered |
| I35.8 | ICD10CM | Covered |
| I35.9 | ICD10CM | Covered |
| I36.0 | ICD10CM | Covered |
| I36.1 | ICD10CM | Covered |
| I36.2 | ICD10CM | Covered |
| I36.8 | ICD10CM | Covered |
| I36.9 | ICD10CM | Covered |
| I37.0 | ICD10CM | Covered |
| I37.1 | ICD10CM | Covered |
| I37.2 | ICD10CM | Covered |
| I37.8 | ICD10CM | Covered |
| I37.9 | ICD10CM | Covered |
| I38 | ICD10CM | Covered |
| I39 | ICD10CM | Covered |
| I40.0 | ICD10CM | Covered |
| I40.1 | ICD10CM | Covered |
| I40.8 | ICD10CM | Covered |
| I40.9 | ICD10CM | Covered |
| I41 | ICD10CM | Covered |
| I42.00 | ICD10CM | Covered |
| I42.01 | ICD10CM | Covered |
| I42.09 | ICD10CM | Covered |
| I42.1 | ICD10CM | Covered |
| I42.2 | ICD10CM | Covered |
| I42.3 | ICD10CM | Covered |
| I42.4 | ICD10CM | Covered |
| I42.5 | ICD10CM | Covered |
| I42.6 | ICD10CM | Covered |
| I42.7 | ICD10CM | Covered |
| I42.81 | ICD10CM | Covered |
| I42.89 | ICD10CM | Covered |
| I42.9 | ICD10CM | Covered |
| I43 | ICD10CM | Covered |
| I44.0 | ICD10CM | Covered |
| I44.1 | ICD10CM | Covered |
| I44.2 | ICD10CM | Covered |
| I44.30 | ICD10CM | Covered |
| I44.4 | ICD10CM | Covered |
| I44.5 | ICD10CM | Covered |
| I44.60 | ICD10CM | Covered |
| I44.69 | ICD10CM | Covered |
| I44.7 | ICD10CM | Covered |
| I45.0 | ICD10CM | Covered |
| I45.10 | ICD10CM | Covered |
| I45.19 | ICD10CM | Covered |
| I46.2 | ICD10CM | Covered |
| I46.8 | ICD10CM | Covered |
| I46.9 | ICD10CM | Covered |
| I47.0 | ICD10CM | Covered |
| I47.11 | ICD10CM | Covered |
| I47.22 | ICD10CM | Covered |
| I47.9 | ICD10CM | Covered |
| I48.0 | ICD10CM | Covered |
| I48.11 | ICD10CM | Covered |
| I48.19 | ICD10CM | Covered |
| I48.20 | ICD10CM | Covered |
| I48.21 | ICD10CM | Covered |
| I48.3 | ICD10CM | Covered |
| I48.4 | ICD10CM | Covered |
| I48.91 | ICD10CM | Covered |
| I48.92 | ICD10CM | Covered |
| I49.01 | ICD10CM | Covered |
| I49.02 | ICD10CM | Covered |
| I49.1 | ICD10CM | Covered |
| I49.2 | ICD10CM | Covered |
| I49.3 | ICD10CM | Covered |
| I49.40 | ICD10CM | Covered |
| I49.49 | ICD10CM | Covered |
| I49.5 | ICD10CM | Covered |
| I49.81 | ICD10CM | Covered |
| I49.82 | ICD10CM | Covered |
| I49.89 | ICD10CM | Covered |
| I50.1 | ICD10CM | Covered |
| I50.20 | ICD10CM | Covered |
| I50.21 | ICD10CM | Covered |
| I50.22 | ICD10CM | Covered |
| I50.23 | ICD10CM | Covered |
| I50.30 | ICD10CM | Covered |
| I50.31 | ICD10CM | Covered |
| I50.32 | ICD10CM | Covered |
| I50.33 | ICD10CM | Covered |
| I50.40 | ICD10CM | Covered |
| I50.41 | ICD10CM | Covered |
| I50.42 | ICD10CM | Covered |
| I50.43 | ICD10CM | Covered |
| I50.810 | ICD10CM | Covered |
| I50.811 | ICD10CM | Covered |
| I50.812 | ICD10CM | Covered |
| I50.813 | ICD10CM | Covered |
| I50.814 | ICD10CM | Covered |
| I50.82 | ICD10CM | Covered |
| I50.83 | ICD10CM | Covered |
| I50.84 | ICD10CM | Covered |
| I50.89 | ICD10CM | Covered |
| I50.9 | ICD10CM | Covered |
| I51.0 | ICD10CM | Covered |
| I51.1 | ICD10CM | Covered |
| I51.2 | ICD10CM | Covered |
| I51.3 | ICD10CM | Covered |
| I51.4 | ICD10CM | Covered |
| I51.5 | ICD10CM | Covered |
| I51.7 | ICD10CM | Covered |
| I51.81 | ICD10CM | Covered |
| I51.89 | ICD10CM | Covered |
| I51.9 | ICD10CM | Covered |
| I52 | ICD10CM | Covered |
| I63.111 | ICD10CM | Covered |
| I63.112 | ICD10CM | Covered |
| I63.113 | ICD10CM | Covered |
| I63.12 | ICD10CM | Covered |
| I63.131 | ICD10CM | Covered |
| I63.132 | ICD10CM | Covered |
| I63.133 | ICD10CM | Covered |
| I63.19 | ICD10CM | Covered |
| I63.211 | ICD10CM | Covered |
| I63.212 | ICD10CM | Covered |
| I63.22 | ICD10CM | Covered |
| I63.231 | ICD10CM | Covered |
| I63.232 | ICD10CM | Covered |
| I63.29 | ICD10CM | Covered |
| I63.411 | ICD10CM | Covered |
| I63.412 | ICD10CM | Covered |
| I63.413 | ICD10CM | Covered |
| I63.421 | ICD10CM | Covered |
| I63.422 | ICD10CM | Covered |
| I63.423 | ICD10CM | Covered |
| I63.431 | ICD10CM | Covered |
| I63.432 | ICD10CM | Covered |
| I63.433 | ICD10CM | Covered |
| I63.441 | ICD10CM | Covered |
| I63.442 | ICD10CM | Covered |
| I63.443 | ICD10CM | Covered |
| I63.49 | ICD10CM | Covered |
| I63.511 | ICD10CM | Covered |
| I63.512 | ICD10CM | Covered |
| I63.513 | ICD10CM | Covered |
| I63.521 | ICD10CM | Covered |
| I63.522 | ICD10CM | Covered |
| I63.523 | ICD10CM | Covered |
| I63.531 | ICD10CM | Covered |
| I63.532 | ICD10CM | Covered |
| I63.533 | ICD10CM | Covered |
| I63.541 | ICD10CM | Covered |
| I63.542 | ICD10CM | Covered |
| I63.543 | ICD10CM | Covered |
| I63.59 | ICD10CM | Covered |
| I63.6 | ICD10CM | Covered |
| I63.81 | ICD10CM | Covered |
| I63.89 | ICD10CM | Covered |
| I63.9 | ICD10CM | Covered |
| I66.01 | ICD10CM | Covered |
| I66.02 | ICD10CM | Covered |
| I66.03 | ICD10CM | Covered |
| I66.11 | ICD10CM | Covered |
| I66.12 | ICD10CM | Covered |
| I66.13 | ICD10CM | Covered |
| I66.21 | ICD10CM | Covered |
| I66.22 | ICD10CM | Covered |
| I66.23 | ICD10CM | Covered |
| I66.29 | ICD10CM | Covered |
| I66.3 | ICD10CM | Covered |
| I66.8 | ICD10CM | Covered |
| I67.0 | ICD10CM | Covered |
| I67.841 | ICD10CM | Covered |
| I67.848 | ICD10CM | Covered |
| I67.89 | ICD10CM | Covered |
| I70.0 | ICD10CM | Covered |
| I71.010 | ICD10CM | Covered |
| I71.011 | ICD10CM | Covered |
| I71.012 | ICD10CM | Covered |
| I71.019 | ICD10CM | Covered |
| I71.02 | ICD10CM | Covered |
| I71.03 | ICD10CM | Covered |
| I71.20 | ICD10CM | Covered |
| I71.21 | ICD10CM | Covered |
| I71.22 | ICD10CM | Covered |
| I71.23 | ICD10CM | Covered |
| I71.40 | ICD10CM | Covered |
| I71.41 | ICD10CM | Covered |
| I71.42 | ICD10CM | Covered |
| I71.43 | ICD10CM | Covered |
| I71.60 | ICD10CM | Covered |
| I71.61 | ICD10CM | Covered |
| I71.62 | ICD10CM | Covered |
| I73.89 | ICD10CM | Covered |
| I74.11 | ICD10CM | Covered |
| I74.19 | ICD10CM | Covered |
| I79.0 | ICD10CM | Covered |
| I79.1 | ICD10CM | Covered |
| I79.8 | ICD10CM | Covered |
| I87.1 | ICD10CM | Covered |
| I95.1 | ICD10CM | Covered |
| I95.89 | ICD10CM | Covered |
| I95.9 | ICD10CM | Covered |
| I97.0 | ICD10CM | Covered |
| I97.110 | ICD10CM | Covered |
| I97.111 | ICD10CM | Covered |
| I97.120 | ICD10CM | Covered |
| I97.121 | ICD10CM | Covered |
| I97.130 | ICD10CM | Covered |
| I97.131 | ICD10CM | Covered |
| I97.190 | ICD10CM | Covered |
| I97.191 | ICD10CM | Covered |
| I97.710 | ICD10CM | Covered |
| I97.711 | ICD10CM | Covered |
| I97.790 | ICD10CM | Covered |
| I97.791 | ICD10CM | Covered |
| I97.88 | ICD10CM | Covered |
| I97.89 | ICD10CM | Covered |
| J80 | ICD10CM | Covered |
| J81.0 | ICD10CM | Covered |
| J95.1 | ICD10CM | Covered |
| J95.2 | ICD10CM | Covered |
| J95.3 | ICD10CM | Covered |
| J95.821 | ICD10CM | Covered |
| J95.822 | ICD10CM | Covered |
| J95.84 | ICD10CM | Covered |
| J95.87 | ICD10CM | Covered |
| J96.00 | ICD10CM | Covered |
| J96.01 | ICD10CM | Covered |
| J96.02 | ICD10CM | Covered |
| J96.20 | ICD10CM | Covered |
| J96.21 | ICD10CM | Covered |
| J96.22 | ICD10CM | Covered |
| J98.51 | ICD10CM | Covered |
| J98.59 | ICD10CM | Covered |
| K68.11 | ICD10CM | Covered |
| K68.3 | ICD10CM | Covered |
| M30.0 | ICD10CM | Covered |
| M30.2 | ICD10CM | Covered |
| M30.3 | ICD10CM | Covered |
| M30.8 | ICD10CM | Covered |
| M31.4 | ICD10CM | Covered |
| M31.7 | ICD10CM | Covered |
| M32.0 | ICD10CM | Covered |
| M32.11 | ICD10CM | Covered |
| M32.12 | ICD10CM | Covered |
| M32.19 | ICD10CM | Covered |
| M32.8 | ICD10CM | Covered |
| M32.9 | ICD10CM | Covered |
| M34.0 | ICD10CM | Covered |
| M34.1 | ICD10CM | Covered |
| M34.2 | ICD10CM | Covered |
| M34.89 | ICD10CM | Covered |
| M34.9 | ICD10CM | Covered |
| Q20.0 | ICD10CM | Covered |
| Q20.1 | ICD10CM | Covered |
| Q20.2 | ICD10CM | Covered |
| Q20.3 | ICD10CM | Covered |
| Q20.4 | ICD10CM | Covered |
| Q20.5 | ICD10CM | Covered |
| Q20.6 | ICD10CM | Covered |
| Q20.8 | ICD10CM | Covered |
| Q21.0 | ICD10CM | Covered |
| Q21.10 | ICD10CM | Covered |
| Q21.11 | ICD10CM | Covered |
| Q21.12 | ICD10CM | Covered |
| Q21.13 | ICD10CM | Covered |
| Q21.14 | ICD10CM | Covered |
| Q21.15 | ICD10CM | Covered |
| Q21.16 | ICD10CM | Covered |
| Q21.19 | ICD10CM | Covered |
| Q21.20 | ICD10CM | Covered |
| Q21.21 | ICD10CM | Covered |
| Q21.22 | ICD10CM | Covered |
| Q21.23 | ICD10CM | Covered |
| Q21.3 | ICD10CM | Covered |
| Q21.4 | ICD10CM | Covered |
| Q21.8 | ICD10CM | Covered |
| Q21.9 | ICD10CM | Covered |
| Q22.0 | ICD10CM | Covered |
| Q22.1 | ICD10CM | Covered |
| Q22.2 | ICD10CM | Covered |
| Q22.3 | ICD10CM | Covered |
| Q22.4 | ICD10CM | Covered |
| Q22.5 | ICD10CM | Covered |
| Q22.6 | ICD10CM | Covered |
| Q22.8 | ICD10CM | Covered |
| Q22.9 | ICD10CM | Covered |
| Q23.0 | ICD10CM | Covered |
| Q23.1 | ICD10CM | Covered |
| Q23.2 | ICD10CM | Covered |
| Q23.3 | ICD10CM | Covered |
| Q23.4 | ICD10CM | Covered |
| Q23.81 | ICD10CM | Covered |
| Q23.82 | ICD10CM | Covered |
| Q23.88 | ICD10CM | Covered |
| Q23.9 | ICD10CM | Covered |
| Q24.0 | ICD10CM | Covered |
| Q24.1 | ICD10CM | Covered |
| Q24.2 | ICD10CM | Covered |
| Q24.3 | ICD10CM | Covered |
| Q24.4 | ICD10CM | Covered |
| Q24.5 | ICD10CM | Covered |
| Q24.6 | ICD10CM | Covered |
| Q24.8 | ICD10CM | Covered |
| Q25.0 | ICD10CM | Covered |
| Q25.1 | ICD10CM | Covered |
| Q25.21 | ICD10CM | Covered |
| Q25.29 | ICD10CM | Covered |
| Q25.3 | ICD10CM | Covered |
| Q25.40 | ICD10CM | Covered |
| Q25.41 | ICD10CM | Covered |
| Q25.42 | ICD10CM | Covered |
| Q25.43 | ICD10CM | Covered |
| Q25.44 | ICD10CM | Covered |
| Q25.45 | ICD10CM | Covered |
| Q25.46 | ICD10CM | Covered |
| Q25.47 | ICD10CM | Covered |
| Q25.48 | ICD10CM | Covered |
| Q25.49 | ICD10CM | Covered |
| Q25.5 | ICD10CM | Covered |
| Q25.6 | ICD10CM | Covered |
| Q25.71 | ICD10CM | Covered |
| Q25.72 | ICD10CM | Covered |
| Q25.79 | ICD10CM | Covered |
| Q25.8 | ICD10CM | Covered |
| Q25.9 | ICD10CM | Covered |
| Q26.0 | ICD10CM | Covered |
| Q26.1 | ICD10CM | Covered |
| Q26.2 | ICD10CM | Covered |
| Q26.3 | ICD10CM | Covered |
| Q26.4 | ICD10CM | Covered |
| Q26.8 | ICD10CM | Covered |
| Q26.9 | ICD10CM | Covered |
| Q87.40 | ICD10CM | Covered |
| Q87.410 | ICD10CM | Covered |
| Q87.418 | ICD10CM | Covered |
| Q87.42 | ICD10CM | Covered |
| Q87.43 | ICD10CM | Covered |
| Q87.82 | ICD10CM | Covered |
| Q87.83 | ICD10CM | Covered |
| Q87.84 | ICD10CM | Covered |
| Q87.85 | ICD10CM | Covered |
| Q87.86 | ICD10CM | Covered |
| Q87.88 | ICD10CM | Covered |
| Q89.3 | ICD10CM | Covered |
| R00.1 | ICD10CM | Covered |
| R00.8 | ICD10CM | Covered |
| R00.9 | ICD10CM | Covered |
| R01.0 | ICD10CM | Covered |
| R01.1 | ICD10CM | Covered |
| R01.2 | ICD10CM | Covered |
| R06.00 | ICD10CM | Covered |
| R06.01 | ICD10CM | Covered |
| R06.02 | ICD10CM | Covered |
| R06.03 | ICD10CM | Covered |
| R06.09 | ICD10CM | Covered |
| R06.2 | ICD10CM | Covered |
| R06.3 | ICD10CM | Covered |
| R06.81 | ICD10CM | Covered |
| R06.82 | ICD10CM | Covered |
| R06.83 | ICD10CM | Covered |
| R06.89 | ICD10CM | Covered |
| R07.1 | ICD10CM | Covered |
| R07.2 | ICD10CM | Covered |
| R07.81 | ICD10CM | Covered |
| R07.82 | ICD10CM | Covered |
| R07.89 | ICD10CM | Covered |
| R07.9 | ICD10CM | Covered |
| R40.2A | ICD10CM | Covered |
| R40.3 | ICD10CM | Covered |
| R40.4 | ICD10CM | Covered |
| R50.2 | ICD10CM | Covered |
| R50.81 | ICD10CM | Covered |
| R50.9 | ICD10CM | Covered |
| R55 | ICD10CM | Covered |
| R57.0 | ICD10CM | Covered |
| R57.1 | ICD10CM | Covered |
| R57.8 | ICD10CM | Covered |
| R57.9 | ICD10CM | Covered |
| R60.0 | ICD10CM | Covered |
| R60.1 | ICD10CM | Covered |
| R65.21 | ICD10CM | Covered |
| R78.81 | ICD10CM | Covered |
| R93.1 | ICD10CM | Covered |
| R94.30 | ICD10CM | Covered |
| R94.31 | ICD10CM | Covered |
| R94.39 | ICD10CM | Covered |
| S21.301A | ICD10CM | Covered |
| S21.301D | ICD10CM | Covered |
| S21.301S | ICD10CM | Covered |
| S21.302A | ICD10CM | Covered |
| S21.302D | ICD10CM | Covered |
| S21.302S | ICD10CM | Covered |
| S21.311A | ICD10CM | Covered |
| S21.311D | ICD10CM | Covered |
| S21.311S | ICD10CM | Covered |
| S21.312A | ICD10CM | Covered |
| S21.312D | ICD10CM | Covered |
| S21.312S | ICD10CM | Covered |
| S21.321A | ICD10CM | Covered |
| S21.321D | ICD10CM | Covered |
| S21.321S | ICD10CM | Covered |
| S21.322A | ICD10CM | Covered |
| S21.322D | ICD10CM | Covered |
| S21.322S | ICD10CM | Covered |
| S21.331A | ICD10CM | Covered |
| S21.331D | ICD10CM | Covered |
| S21.331S | ICD10CM | Covered |
| S21.332A | ICD10CM | Covered |
| S21.332D | ICD10CM | Covered |
| S21.332S | ICD10CM | Covered |
| S21.341A | ICD10CM | Covered |
| S21.341D | ICD10CM | Covered |
| S21.341S | ICD10CM | Covered |
| S21.342A | ICD10CM | Covered |
| S21.342D | ICD10CM | Covered |
| S21.342S | ICD10CM | Covered |
| S21.351A | ICD10CM | Covered |
| S21.351D | ICD10CM | Covered |
| S21.351S | ICD10CM | Covered |
| S21.352A | ICD10CM | Covered |
| S21.352D | ICD10CM | Covered |
| S21.352S | ICD10CM | Covered |
| S21.401A | ICD10CM | Covered |
| S21.401D | ICD10CM | Covered |
| S21.401S | ICD10CM | Covered |
| S21.402A | ICD10CM | Covered |
| S21.402D | ICD10CM | Covered |
| S21.402S | ICD10CM | Covered |
| S21.411A | ICD10CM | Covered |
| S21.411D | ICD10CM | Covered |
| S21.411S | ICD10CM | Covered |
| S21.412A | ICD10CM | Covered |
| S21.412D | ICD10CM | Covered |
| S21.412S | ICD10CM | Covered |
| S21.421A | ICD10CM | Covered |
| S21.421D | ICD10CM | Covered |
| S21.421S | ICD10CM | Covered |
| S21.422A | ICD10CM | Covered |
| S21.422D | ICD10CM | Covered |
| S21.422S | ICD10CM | Covered |
| S21.431A | ICD10CM | Covered |
| S21.431D | ICD10CM | Covered |
| S21.431S | ICD10CM | Covered |
| S21.432A | ICD10CM | Covered |
| S21.432D | ICD10CM | Covered |
| S21.432S | ICD10CM | Covered |
| S21.441A | ICD10CM | Covered |
| S21.441D | ICD10CM | Covered |
| S21.441S | ICD10CM | Covered |
| S21.442A | ICD10CM | Covered |
| S21.442D | ICD10CM | Covered |
| S21.442S | ICD10CM | Covered |
| S21.451A | ICD10CM | Covered |
| S21.451D | ICD10CM | Covered |
| S21.451S | ICD10CM | Covered |
| S21.452A | ICD10CM | Covered |
| S21.452D | ICD10CM | Covered |
| S21.452S | ICD10CM | Covered |
| S22.5XXA | ICD10CM | Covered |
| S22.5XXB | ICD10CM | Covered |
| S22.5XXD | ICD10CM | Covered |
| S22.5XXG | ICD10CM | Covered |
| S22.5XXK | ICD10CM | Covered |
| S22.5XXS | ICD10CM | Covered |
| S25.00XA | ICD10CM | Covered |
| S25.00XD | ICD10CM | Covered |
| S25.00XS | ICD10CM | Covered |
| S25.01XA | ICD10CM | Covered |
| S25.01XD | ICD10CM | Covered |
| S25.01XS | ICD10CM | Covered |
| S25.02XA | ICD10CM | Covered |
| S25.02XD | ICD10CM | Covered |
| S25.02XS | ICD10CM | Covered |
| S25.09XA | ICD10CM | Covered |
| S25.09XD | ICD10CM | Covered |
| S25.09XS | ICD10CM | Covered |
| S25.20XA | ICD10CM | Covered |
| S25.20XD | ICD10CM | Covered |
| S25.20XS | ICD10CM | Covered |
| S25.21XA | ICD10CM | Covered |
| S25.21XD | ICD10CM | Covered |
| S25.21XS | ICD10CM | Covered |
| S25.22XA | ICD10CM | Covered |
| S25.22XD | ICD10CM | Covered |
| S25.22XS | ICD10CM | Covered |
| S25.29XA | ICD10CM | Covered |
| S25.29XD | ICD10CM | Covered |
| S25.29XS | ICD10CM | Covered |
| S25.401A | ICD10CM | Covered |
| S25.401D | ICD10CM | Covered |
| S25.401S | ICD10CM | Covered |
| S25.402A | ICD10CM | Covered |
| S25.402D | ICD10CM | Covered |
| S25.402S | ICD10CM | Covered |
| S25.411A | ICD10CM | Covered |
| S25.411D | ICD10CM | Covered |
| S25.411S | ICD10CM | Covered |
| S25.412A | ICD10CM | Covered |
| S25.412D | ICD10CM | Covered |
| S25.412S | ICD10CM | Covered |
| S25.421A | ICD10CM | Covered |
| S25.421D | ICD10CM | Covered |
| S25.421S | ICD10CM | Covered |
| S25.422A | ICD10CM | Covered |
| S25.422D | ICD10CM | Covered |
| S25.422S | ICD10CM | Covered |
| S25.491A | ICD10CM | Covered |
| S25.491D | ICD10CM | Covered |
| S25.491S | ICD10CM | Covered |
| S25.492A | ICD10CM | Covered |
| S25.492D | ICD10CM | Covered |
| S25.492S | ICD10CM | Covered |
| S26.00XA | ICD10CM | Covered |
| S26.00XD | ICD10CM | Covered |
| S26.00XS | ICD10CM | Covered |
| S26.01XA | ICD10CM | Covered |
| S26.01XD | ICD10CM | Covered |
| S26.01XS | ICD10CM | Covered |
| S26.020A | ICD10CM | Covered |
| S26.020D | ICD10CM | Covered |
| S26.020S | ICD10CM | Covered |
| S26.021A | ICD10CM | Covered |
| S26.021D | ICD10CM | Covered |
| S26.021S | ICD10CM | Covered |
| S26.022A | ICD10CM | Covered |
| S26.022D | ICD10CM | Covered |
| S26.022S | ICD10CM | Covered |
| S26.09XA | ICD10CM | Covered |
| S26.09XD | ICD10CM | Covered |
| S26.09XS | ICD10CM | Covered |
| S26.10XA | ICD10CM | Covered |
| S26.10XD | ICD10CM | Covered |
| S26.10XS | ICD10CM | Covered |
| S26.11XA | ICD10CM | Covered |
| S26.11XD | ICD10CM | Covered |
| S26.11XS | ICD10CM | Covered |
| S26.12XA | ICD10CM | Covered |
| S26.12XD | ICD10CM | Covered |
| S26.12XS | ICD10CM | Covered |
| S26.19XA | ICD10CM | Covered |
| S26.19XD | ICD10CM | Covered |
| S26.19XS | ICD10CM | Covered |
| S26.90XA | ICD10CM | Covered |
| S26.90XD | ICD10CM | Covered |
| S26.90XS | ICD10CM | Covered |
| S26.91XA | ICD10CM | Covered |
| S26.91XD | ICD10CM | Covered |
| S26.91XS | ICD10CM | Covered |
| S26.92XA | ICD10CM | Covered |
| S26.92XD | ICD10CM | Covered |
| S26.92XS | ICD10CM | Covered |
| S26.99XA | ICD10CM | Covered |
| S26.99XD | ICD10CM | Covered |
| S26.99XS | ICD10CM | Covered |
| S28.1XXA | ICD10CM | Covered |
| S28.1XXD | ICD10CM | Covered |
| S28.1XXS | ICD10CM | Covered |
| S29.8XXA | ICD10CM | Covered |
| S29.8XXD | ICD10CM | Covered |
| S29.8XXS | ICD10CM | Covered |
| T36.0X5D | ICD10CM | Covered |
| T36.0X5S | ICD10CM | Covered |
| T36.1X5D | ICD10CM | Covered |
| T36.1X5S | ICD10CM | Covered |
| T36.2X5D | ICD10CM | Covered |
| T36.2X5S | ICD10CM | Covered |
| T36.3X5D | ICD10CM | Covered |
| T36.3X5S | ICD10CM | Covered |
| T36.4X5D | ICD10CM | Covered |
| T36.4X5S | ICD10CM | Covered |
| T36.5X5D | ICD10CM | Covered |
| T36.5X5S | ICD10CM | Covered |
| T36.6X5D | ICD10CM | Covered |
| T36.6X5S | ICD10CM | Covered |
| T36.7X5D | ICD10CM | Covered |
| T36.7X5S | ICD10CM | Covered |
| T36.8X5D | ICD10CM | Covered |
| T36.8X5S | ICD10CM | Covered |
| T36.95XD | ICD10CM | Covered |
| T36.95XS | ICD10CM | Covered |
| T37.0X5D | ICD10CM | Covered |
| T37.0X5S | ICD10CM | Covered |
| T37.1X5D | ICD10CM | Covered |
| T37.1X5S | ICD10CM | Covered |
| T37.2X5D | ICD10CM | Covered |
| T37.2X5S | ICD10CM | Covered |
| T37.3X5D | ICD10CM | Covered |
| T37.3X5S | ICD10CM | Covered |
| T37.4X5D | ICD10CM | Covered |
| T37.4X5S | ICD10CM | Covered |
| T37.5X5D | ICD10CM | Covered |
| T37.5X5S | ICD10CM | Covered |
| T37.8X5D | ICD10CM | Covered |
| T37.8X5S | ICD10CM | Covered |
| T37.95XD | ICD10CM | Covered |
| T37.95XS | ICD10CM | Covered |
| T38.0X1A | ICD10CM | Covered |
| T38.0X1D | ICD10CM | Covered |
| T38.0X1S | ICD10CM | Covered |
| T38.0X2A | ICD10CM | Covered |
| T38.0X2D | ICD10CM | Covered |
| T38.0X2S | ICD10CM | Covered |
| T38.0X3A | ICD10CM | Covered |
| T38.0X3D | ICD10CM | Covered |
| T38.0X3S | ICD10CM | Covered |
| T38.0X4A | ICD10CM | Covered |
| T38.0X4D | ICD10CM | Covered |
| T38.0X4S | ICD10CM | Covered |
| T38.0X5D | ICD10CM | Covered |
| T38.0X5S | ICD10CM | Covered |
| T38.1X5D | ICD10CM | Covered |
| T38.1X5S | ICD10CM | Covered |
| T38.2X5D | ICD10CM | Covered |
| T38.2X5S | ICD10CM | Covered |
| T38.3X5D | ICD10CM | Covered |
| T38.3X5S | ICD10CM | Covered |
| T38.4X5D | ICD10CM | Covered |
| T38.4X5S | ICD10CM | Covered |
| T38.5X5D | ICD10CM | Covered |
| T38.5X5S | ICD10CM | Covered |
| T38.6X5D | ICD10CM | Covered |
| T38.6X5S | ICD10CM | Covered |
| T38.7X5D | ICD10CM | Covered |
| T38.7X5S | ICD10CM | Covered |
| T38.805D | ICD10CM | Covered |
| T38.805S | ICD10CM | Covered |
| T38.815D | ICD10CM | Covered |
| T38.815S | ICD10CM | Covered |
| T38.895D | ICD10CM | Covered |
| T38.895S | ICD10CM | Covered |
| T38.905D | ICD10CM | Covered |
| T38.905S | ICD10CM | Covered |
| T38.995D | ICD10CM | Covered |
| T38.995S | ICD10CM | Covered |
| T39.015D | ICD10CM | Covered |
| T39.015S | ICD10CM | Covered |
| T39.095D | ICD10CM | Covered |
| T39.095S | ICD10CM | Covered |
| T39.1X5D | ICD10CM | Covered |
| T39.1X5S | ICD10CM | Covered |
| T39.2X5D | ICD10CM | Covered |
| T39.2X5S | ICD10CM | Covered |
| T39.315D | ICD10CM | Covered |
| T39.315S | ICD10CM | Covered |
| T39.395D | ICD10CM | Covered |
| T39.395S | ICD10CM | Covered |
| T39.4X5D | ICD10CM | Covered |
| T39.4X5S | ICD10CM | Covered |
| T39.8X5D | ICD10CM | Covered |
| T39.8X5S | ICD10CM | Covered |
| T39.95XD | ICD10CM | Covered |
| T39.95XS | ICD10CM | Covered |
| T40.0X5D | ICD10CM | Covered |
| T40.0X5S | ICD10CM | Covered |