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 2,135 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 93880 | HCPCS | Covered |
| 93882 | HCPCS | Covered |
| 93886 | HCPCS | Covered |
| 93888 | HCPCS | Covered |
| 93892 | HCPCS | Covered |
| 93893 | HCPCS | Covered |
| 93896 | HCPCS | Covered |
| 93897 | HCPCS | Covered |
| 93898 | HCPCS | Covered |
| 93922 | HCPCS | Covered |
| 93923 | HCPCS | Covered |
| 93924 | HCPCS | Covered |
| 93925 | HCPCS | Covered |
| 93926 | HCPCS | Covered |
| 93930 | HCPCS | Covered |
| 93931 | HCPCS | Covered |
| 93970 | HCPCS | Covered |
| 93971 | HCPCS | Covered |
| 93975 | HCPCS | Covered |
| 93976 | HCPCS | Covered |
| 93978 | HCPCS | Covered |
| 93979 | HCPCS | Covered |
| 93985 | HCPCS | Covered |
| 93986 | HCPCS | Covered |
| 93990 | HCPCS | Covered |
| C22.0 | ICD10CM | Covered |
| C22.1 | ICD10CM | Covered |
| C22.2 | ICD10CM | Covered |
| C22.3 | ICD10CM | Covered |
| C22.4 | ICD10CM | Covered |
| C22.7 | ICD10CM | Covered |
| D57.01 | ICD10CM | Covered |
| D57.02 | ICD10CM | Covered |
| D57.03 | ICD10CM | Covered |
| D57.04 | ICD10CM | Covered |
| D57.09 | ICD10CM | Covered |
| D57.1 | ICD10CM | Covered |
| D57.40 | ICD10CM | Covered |
| D57.411 | ICD10CM | Covered |
| D57.412 | ICD10CM | Covered |
| D57.413 | ICD10CM | Covered |
| D57.414 | ICD10CM | Covered |
| D57.418 | ICD10CM | Covered |
| D57.42 | ICD10CM | Covered |
| D57.431 | ICD10CM | Covered |
| D57.432 | ICD10CM | Covered |
| D57.433 | ICD10CM | Covered |
| D57.434 | ICD10CM | Covered |
| D57.438 | ICD10CM | Covered |
| D57.439 | ICD10CM | Covered |
| D57.44 | ICD10CM | Covered |
| D57.451 | ICD10CM | Covered |
| D57.452 | ICD10CM | Covered |
| D57.453 | ICD10CM | Covered |
| D57.454 | ICD10CM | Covered |
| D57.458 | ICD10CM | Covered |
| D57.459 | ICD10CM | Covered |
| E08.52 | ICD10CM | Covered |
| E09.52 | ICD10CM | Covered |
| E09.59 | ICD10CM | Covered |
| E10.52 | ICD10CM | Covered |
| E10.59 | ICD10CM | Covered |
| E11.52 | ICD10CM | Covered |
| E11.59 | ICD10CM | Covered |
| E13.52 | ICD10CM | Covered |
| E13.59 | ICD10CM | Covered |
| F52.21 | ICD10CM | Covered |
| F52.22 | ICD10CM | Covered |
| F52.8 | ICD10CM | Covered |
| G45.0 | ICD10CM | Covered |
| G45.1 | ICD10CM | Covered |
| G45.2 | ICD10CM | Covered |
| G45.3 | ICD10CM | Covered |
| G45.4 | ICD10CM | Covered |
| G45.8 | ICD10CM | Covered |
| G45.9 | ICD10CM | Covered |
| G46.0 | ICD10CM | Covered |
| G46.1 | ICD10CM | Covered |
| G46.2 | ICD10CM | Covered |
| G54.0 | 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 |
| 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 |
| G83.31 | ICD10CM | Covered |
| G83.32 | ICD10CM | Covered |
| G93.82 | 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 |
| H34.8110 | ICD10CM | Covered |
| H34.8111 | ICD10CM | Covered |
| H34.8112 | ICD10CM | Covered |
| H34.8120 | ICD10CM | Covered |
| H34.8121 | ICD10CM | Covered |
| H34.8122 | ICD10CM | Covered |
| H34.8130 | ICD10CM | Covered |
| H34.8131 | ICD10CM | Covered |
| H34.8132 | ICD10CM | Covered |
| H34.821 | ICD10CM | Covered |
| H34.822 | ICD10CM | Covered |
| H34.823 | ICD10CM | Covered |
| H34.8310 | ICD10CM | Covered |
| H34.8311 | ICD10CM | Covered |
| H34.8312 | ICD10CM | Covered |
| H34.8320 | ICD10CM | Covered |
| H34.8321 | ICD10CM | Covered |
| H34.8322 | ICD10CM | Covered |
| H34.8330 | ICD10CM | Covered |
| H34.8331 | ICD10CM | Covered |
| H34.8332 | ICD10CM | Covered |
| H35.82 | ICD10CM | Covered |
| H53.11 | ICD10CM | Covered |
| H53.121 | ICD10CM | Covered |
| H53.122 | ICD10CM | Covered |
| H53.123 | ICD10CM | Covered |
| H53.131 | ICD10CM | Covered |
| H53.132 | ICD10CM | Covered |
| H53.133 | ICD10CM | Covered |
| H53.2 | ICD10CM | Covered |
| H53.411 | ICD10CM | Covered |
| H53.412 | ICD10CM | Covered |
| H53.413 | ICD10CM | Covered |
| H53.421 | ICD10CM | Covered |
| H53.422 | ICD10CM | Covered |
| H53.423 | ICD10CM | Covered |
| H53.431 | ICD10CM | Covered |
| H53.432 | ICD10CM | Covered |
| H53.433 | ICD10CM | Covered |
| H53.451 | ICD10CM | Covered |
| H53.452 | ICD10CM | Covered |
| H53.453 | ICD10CM | Covered |
| H53.461 | ICD10CM | Covered |
| H53.462 | ICD10CM | Covered |
| H53.47 | ICD10CM | Covered |
| H53.481 | ICD10CM | Covered |
| H53.482 | ICD10CM | Covered |
| H53.483 | ICD10CM | Covered |
| H53.8 | ICD10CM | Covered |
| H53.9 | ICD10CM | Covered |
| H59.211 | ICD10CM | Covered |
| H59.212 | ICD10CM | Covered |
| H59.213 | ICD10CM | Covered |
| H59.221 | ICD10CM | Covered |
| H59.222 | ICD10CM | Covered |
| H59.223 | ICD10CM | Covered |
| I10 | 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 |
| I16.0 | ICD10CM | Covered |
| I16.1 | ICD10CM | Covered |
| I16.9 | ICD10CM | Covered |
| I20.0 | ICD10CM | Covered |
| I20.81 | ICD10CM | Covered |
| I20.89 | 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 |
| I24.0 | ICD10CM | Covered |
| I24.81 | ICD10CM | Covered |
| I24.89 | ICD10CM | Covered |
| I25.10 | ICD10CM | Covered |
| I25.110 | ICD10CM | Covered |
| I25.111 | ICD10CM | Covered |
| I25.118 | ICD10CM | Covered |
| I25.710 | ICD10CM | Covered |
| I25.711 | ICD10CM | Covered |
| I25.718 | ICD10CM | Covered |
| I25.720 | ICD10CM | Covered |
| I25.721 | ICD10CM | Covered |
| I25.728 | ICD10CM | Covered |
| I25.730 | ICD10CM | Covered |
| I25.731 | ICD10CM | Covered |
| I25.738 | ICD10CM | Covered |
| I25.750 | ICD10CM | Covered |
| I25.751 | ICD10CM | Covered |
| I25.758 | ICD10CM | Covered |
| I25.760 | ICD10CM | Covered |
| I25.761 | ICD10CM | Covered |
| I25.768 | ICD10CM | Covered |
| I25.790 | ICD10CM | Covered |
| I25.791 | ICD10CM | Covered |
| I25.798 | ICD10CM | Covered |
| I25.810 | ICD10CM | Covered |
| I25.811 | ICD10CM | Covered |
| I25.85 | ICD10CM | Covered |
| I26.01 | ICD10CM | Covered |
| I26.02 | ICD10CM | Covered |
| I26.09 | ICD10CM | Covered |
| I26.90 | ICD10CM | Covered |
| I26.92 | ICD10CM | Covered |
| I26.99 | ICD10CM | Covered |
| I27.82 | ICD10CM | Covered |
| I60.01 | ICD10CM | Covered |
| I60.02 | ICD10CM | Covered |
| I60.11 | ICD10CM | Covered |
| I60.12 | ICD10CM | Covered |
| I60.2 | ICD10CM | Covered |
| I60.31 | ICD10CM | Covered |
| I60.32 | ICD10CM | Covered |
| I60.4 | ICD10CM | Covered |
| I60.51 | ICD10CM | Covered |
| I60.52 | ICD10CM | Covered |
| I60.6 | ICD10CM | Covered |
| I60.8 | ICD10CM | Covered |
| I63.00 | ICD10CM | Covered |
| I63.011 | ICD10CM | Covered |
| I63.012 | ICD10CM | Covered |
| I63.02 | ICD10CM | Covered |
| I63.031 | ICD10CM | Covered |
| I63.032 | ICD10CM | Covered |
| I63.09 | ICD10CM | Covered |
| I63.111 | ICD10CM | Covered |
| I63.112 | ICD10CM | Covered |
| I63.12 | ICD10CM | Covered |
| I63.131 | ICD10CM | Covered |
| I63.132 | ICD10CM | Covered |
| I63.19 | ICD10CM | Covered |
| I63.20 | ICD10CM | Covered |
| I63.211 | ICD10CM | Covered |
| I63.212 | ICD10CM | Covered |
| I63.22 | ICD10CM | Covered |
| I63.231 | ICD10CM | Covered |
| I63.232 | ICD10CM | Covered |
| I63.311 | ICD10CM | Covered |
| I63.312 | ICD10CM | Covered |
| I63.321 | ICD10CM | Covered |
| I63.322 | ICD10CM | Covered |
| I63.331 | ICD10CM | Covered |
| I63.332 | ICD10CM | Covered |
| I63.341 | ICD10CM | Covered |
| I63.342 | ICD10CM | Covered |
| I63.39 | ICD10CM | Covered |
| I63.411 | ICD10CM | Covered |
| I63.412 | ICD10CM | Covered |
| I63.421 | ICD10CM | Covered |
| I63.422 | ICD10CM | Covered |
| I63.431 | ICD10CM | Covered |
| I63.432 | ICD10CM | Covered |
| I63.441 | ICD10CM | Covered |
| I63.442 | ICD10CM | Covered |
| I63.49 | ICD10CM | Covered |
| I63.6 | ICD10CM | Covered |
| I63.81 | ICD10CM | Covered |
| I63.89 | ICD10CM | Covered |
| I63.9 | ICD10CM | Covered |
| I65.01 | ICD10CM | Covered |
| I65.02 | ICD10CM | Covered |
| I65.03 | ICD10CM | Covered |
| I65.1 | ICD10CM | Covered |
| I65.21 | ICD10CM | Covered |
| I65.22 | ICD10CM | Covered |
| I65.23 | ICD10CM | Covered |
| I65.29 | ICD10CM | Covered |
| I65.8 | 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 |
| I66.3 | ICD10CM | Covered |
| I66.8 | ICD10CM | Covered |
| I67.0 | ICD10CM | Covered |
| I67.841 | ICD10CM | Covered |
| I67.848 | ICD10CM | Covered |
| I70.0 | ICD10CM | Covered |
| I70.1 | ICD10CM | Covered |
| I70.201 | ICD10CM | Covered |
| I70.202 | ICD10CM | Covered |
| I70.203 | ICD10CM | Covered |
| I70.208 | ICD10CM | Covered |
| I70.211 | ICD10CM | Covered |
| I70.212 | ICD10CM | Covered |
| I70.213 | ICD10CM | Covered |
| I70.218 | ICD10CM | Covered |
| I70.221 | ICD10CM | Covered |
| I70.222 | ICD10CM | Covered |
| I70.223 | ICD10CM | Covered |
| I70.228 | 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 |
| I70.239 | 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 |
| I70.249 | ICD10CM | Covered |
| I70.25 | ICD10CM | Covered |
| I70.261 | ICD10CM | Covered |
| I70.262 | ICD10CM | Covered |
| I70.263 | ICD10CM | Covered |
| I70.268 | ICD10CM | Covered |
| I70.411 | ICD10CM | Covered |
| I70.412 | ICD10CM | Covered |
| I70.413 | ICD10CM | Covered |
| I70.418 | ICD10CM | Covered |
| I70.421 | ICD10CM | Covered |
| I70.422 | ICD10CM | Covered |
| I70.423 | ICD10CM | Covered |
| I70.428 | 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 |
| I70.449 | ICD10CM | Covered |
| I70.45 | ICD10CM | Covered |
| I70.461 | ICD10CM | Covered |
| I70.462 | ICD10CM | Covered |
| I70.463 | ICD10CM | Covered |
| I70.468 | ICD10CM | Covered |
| I70.491 | ICD10CM | Covered |
| I70.492 | ICD10CM | Covered |
| I70.493 | ICD10CM | Covered |
| I70.498 | ICD10CM | Covered |
| I70.501 | ICD10CM | Covered |
| I70.502 | ICD10CM | Covered |
| I70.503 | ICD10CM | Covered |
| I70.508 | ICD10CM | Covered |
| I70.511 | ICD10CM | Covered |
| I70.512 | ICD10CM | Covered |
| I70.513 | ICD10CM | Covered |
| I70.518 | ICD10CM | Covered |
| I70.521 | ICD10CM | Covered |
| I70.522 | ICD10CM | Covered |
| I70.523 | ICD10CM | Covered |
| I70.528 | 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 |
| I70.539 | ICD10CM | Covered |
| I70.541 | ICD10CM | Covered |
| I70.542 | ICD10CM | Covered |
| I70.543 | ICD10CM | Covered |
| I70.544 | ICD10CM | Covered |
| I70.545 | ICD10CM | Covered |
| I70.548 | 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 |
| I70.591 | ICD10CM | Covered |
| I70.592 | ICD10CM | Covered |
| I70.593 | ICD10CM | Covered |
| I70.598 | ICD10CM | Covered |
| I70.601 | ICD10CM | Covered |
| I70.602 | ICD10CM | Covered |
| I70.603 | ICD10CM | Covered |
| I70.608 | ICD10CM | Covered |
| I70.611 | ICD10CM | Covered |
| I70.612 | ICD10CM | Covered |
| I70.613 | ICD10CM | Covered |
| I70.618 | ICD10CM | Covered |
| I70.621 | ICD10CM | Covered |
| I70.622 | ICD10CM | Covered |
| I70.623 | ICD10CM | Covered |
| I70.628 | 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 |
| I70.639 | 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 |
| I70.649 | ICD10CM | Covered |
| I70.65 | ICD10CM | Covered |
| I70.661 | ICD10CM | Covered |
| I70.662 | ICD10CM | Covered |
| I70.663 | ICD10CM | Covered |
| I70.668 | ICD10CM | Covered |
| I70.691 | ICD10CM | Covered |
| I70.692 | ICD10CM | Covered |
| I70.693 | ICD10CM | Covered |
| I70.698 | ICD10CM | Covered |
| I70.701 | ICD10CM | Covered |
| I70.702 | ICD10CM | Covered |
| I70.703 | ICD10CM | Covered |
| I70.708 | ICD10CM | Covered |
| I70.711 | ICD10CM | Covered |
| I70.712 | ICD10CM | Covered |
| I70.713 | ICD10CM | Covered |
| I70.718 | ICD10CM | Covered |
| I70.721 | ICD10CM | Covered |
| I70.722 | ICD10CM | Covered |
| I70.723 | ICD10CM | Covered |
| I70.728 | 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 |
| I70.739 | 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 |
| I70.749 | ICD10CM | Covered |
| I70.75 | ICD10CM | Covered |
| I70.761 | ICD10CM | Covered |
| I70.762 | ICD10CM | Covered |
| I70.763 | ICD10CM | Covered |
| I70.768 | ICD10CM | Covered |
| I70.791 | ICD10CM | Covered |
| I70.792 | ICD10CM | Covered |
| I70.793 | ICD10CM | Covered |
| I70.798 | ICD10CM | Covered |
| I70.92 | 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 |
| I71.10 | ICD10CM | Covered |
| I71.11 | ICD10CM | Covered |
| I71.12 | ICD10CM | Covered |
| I71.13 | ICD10CM | Covered |
| I71.20 | ICD10CM | Covered |
| I71.21 | ICD10CM | Covered |
| I71.22 | ICD10CM | Covered |
| I71.23 | ICD10CM | Covered |
| I71.30 | ICD10CM | Covered |
| I71.31 | ICD10CM | Covered |
| I71.32 | ICD10CM | Covered |
| I71.33 | ICD10CM | Covered |
| I71.40 | ICD10CM | Covered |
| I71.41 | ICD10CM | Covered |
| I71.42 | ICD10CM | Covered |
| I71.43 | ICD10CM | Covered |
| I71.50 | ICD10CM | Covered |
| I71.51 | ICD10CM | Covered |
| I71.52 | ICD10CM | Covered |
| I71.60 | ICD10CM | Covered |
| I71.61 | ICD10CM | Covered |
| I71.62 | ICD10CM | Covered |
| I72.0 | ICD10CM | Covered |
| I72.1 | ICD10CM | Covered |
| I72.2 | ICD10CM | Covered |
| I72.3 | ICD10CM | Covered |
| I72.4 | ICD10CM | Covered |
| I72.5 | ICD10CM | Covered |
| I72.6 | ICD10CM | Covered |
| I72.8 | ICD10CM | Covered |
| I73.00 | ICD10CM | Covered |
| I73.01 | ICD10CM | Covered |
| I73.1 | ICD10CM | Covered |
| I73.89 | ICD10CM | Covered |
| I73.9 | ICD10CM | Covered |
| I74.01 | ICD10CM | Covered |
| I74.09 | ICD10CM | Covered |
| I74.11 | ICD10CM | Covered |
| I74.19 | ICD10CM | Covered |
| I74.2 | ICD10CM | Covered |
| I74.3 | ICD10CM | Covered |
| I74.5 | ICD10CM | Covered |
| I74.8 | ICD10CM | Covered |
| I75.011 | ICD10CM | Covered |
| I75.012 | ICD10CM | Covered |
| I75.013 | ICD10CM | Covered |
| I75.021 | ICD10CM | Covered |
| I75.022 | ICD10CM | Covered |
| I75.023 | ICD10CM | Covered |
| I75.81 | ICD10CM | Covered |
| I75.89 | ICD10CM | Covered |
| I76 | ICD10CM | Covered |
| I77.0 | ICD10CM | Covered |
| I77.1 | ICD10CM | Covered |
| I77.3 | ICD10CM | Covered |
| I77.4 | ICD10CM | Covered |
| I77.70 | ICD10CM | Covered |
| I77.71 | ICD10CM | Covered |
| I77.72 | ICD10CM | Covered |
| I77.73 | ICD10CM | Covered |
| I77.74 | ICD10CM | Covered |
| I77.75 | ICD10CM | Covered |
| I77.76 | ICD10CM | Covered |
| I77.77 | ICD10CM | Covered |
| I77.79 | ICD10CM | Covered |
| I77.810 | ICD10CM | Covered |
| I77.811 | ICD10CM | Covered |
| I77.812 | ICD10CM | Covered |
| I77.82 | ICD10CM | Covered |
| I77.89 | ICD10CM | Covered |
| I79.1 | ICD10CM | Covered |
| I79.8 | ICD10CM | Covered |
| I80.01 | ICD10CM | Covered |
| I80.02 | ICD10CM | Covered |
| I80.03 | ICD10CM | Covered |
| I80.11 | ICD10CM | Covered |
| I80.12 | ICD10CM | Covered |
| I80.13 | ICD10CM | Covered |
| I80.211 | ICD10CM | Covered |
| I80.212 | ICD10CM | Covered |
| I80.213 | ICD10CM | Covered |
| I80.221 | ICD10CM | Covered |
| I80.222 | ICD10CM | Covered |
| I80.223 | ICD10CM | Covered |
| I80.231 | ICD10CM | Covered |
| I80.232 | ICD10CM | Covered |
| I80.233 | ICD10CM | Covered |
| I80.241 | ICD10CM | Covered |
| I80.242 | ICD10CM | Covered |
| I80.243 | ICD10CM | Covered |
| I80.251 | ICD10CM | Covered |
| I80.252 | ICD10CM | Covered |
| I80.253 | ICD10CM | Covered |
| I80.291 | ICD10CM | Covered |
| I80.292 | ICD10CM | Covered |
| I80.293 | ICD10CM | Covered |
| I80.3 | ICD10CM | Covered |
| I80.8 | ICD10CM | Covered |
| I81 | ICD10CM | Covered |
| I82.0 | ICD10CM | Covered |
| I82.1 | ICD10CM | Covered |
| I82.220 | ICD10CM | Covered |
| I82.221 | ICD10CM | Covered |
| I82.3 | ICD10CM | Covered |
| I82.401 | ICD10CM | Covered |
| I82.402 | ICD10CM | Covered |
| I82.403 | ICD10CM | Covered |
| I82.411 | ICD10CM | Covered |
| I82.412 | ICD10CM | Covered |
| I82.413 | ICD10CM | Covered |
| I82.421 | ICD10CM | Covered |
| I82.422 | ICD10CM | Covered |
| I82.423 | ICD10CM | Covered |
| I82.431 | ICD10CM | Covered |
| I82.432 | ICD10CM | Covered |
| I82.433 | ICD10CM | Covered |
| I82.441 | ICD10CM | Covered |
| I82.442 | ICD10CM | Covered |
| I82.443 | ICD10CM | Covered |
| I82.451 | ICD10CM | Covered |
| I82.452 | ICD10CM | Covered |
| I82.453 | ICD10CM | Covered |
| I82.461 | ICD10CM | Covered |
| I82.462 | ICD10CM | Covered |
| I82.463 | ICD10CM | Covered |
| I82.491 | ICD10CM | Covered |
| I82.492 | ICD10CM | Covered |
| I82.493 | ICD10CM | Covered |
| I82.4Y1 | ICD10CM | Covered |
| I82.4Y2 | ICD10CM | Covered |
| I82.4Y3 | ICD10CM | Covered |
| I82.4Y9 | ICD10CM | Covered |
| I82.4Z1 | ICD10CM | Covered |
| I82.4Z2 | ICD10CM | Covered |
| I82.4Z3 | ICD10CM | Covered |
| I82.4Z9 | ICD10CM | Covered |
| I82.511 | ICD10CM | Covered |
| I82.512 | ICD10CM | Covered |
| I82.513 | ICD10CM | Covered |
| I82.521 | ICD10CM | Covered |
| I82.522 | ICD10CM | Covered |
| I82.523 | ICD10CM | Covered |
| I82.531 | ICD10CM | Covered |
| I82.532 | ICD10CM | Covered |
| I82.533 | ICD10CM | Covered |
| I82.541 | ICD10CM | Covered |
| I82.542 | ICD10CM | Covered |
| I82.543 | ICD10CM | Covered |
| I82.551 | ICD10CM | Covered |
| I82.552 | ICD10CM | Covered |
| I82.553 | ICD10CM | Covered |
| I82.561 | ICD10CM | Covered |
| I82.562 | ICD10CM | Covered |
| I82.563 | ICD10CM | Covered |
| I82.591 | ICD10CM | Covered |
| I82.592 | ICD10CM | Covered |
| I82.593 | ICD10CM | Covered |
| I82.5Y1 | ICD10CM | Covered |
| I82.5Y2 | ICD10CM | Covered |
| I82.5Y3 | ICD10CM | Covered |
| I82.5Y9 | ICD10CM | Covered |
| I82.5Z1 | ICD10CM | Covered |
| I82.5Z2 | ICD10CM | Covered |
| I82.5Z3 | ICD10CM | Covered |
| I82.5Z9 | ICD10CM | Covered |
| I82.611 | ICD10CM | Covered |
| I82.612 | ICD10CM | Covered |
| I82.613 | ICD10CM | Covered |
| I82.621 | ICD10CM | Covered |
| I82.622 | ICD10CM | Covered |
| I82.623 | ICD10CM | Covered |
| I82.711 | ICD10CM | Covered |
| I82.712 | ICD10CM | Covered |
| I82.713 | ICD10CM | Covered |
| I82.721 | ICD10CM | Covered |
| I82.722 | ICD10CM | Covered |
| I82.723 | ICD10CM | Covered |
| I82.811 | ICD10CM | Covered |
| I82.812 | ICD10CM | Covered |
| I82.813 | ICD10CM | Covered |
| I82.A11 | ICD10CM | Covered |
| I82.A12 | ICD10CM | Covered |
| I82.A13 | ICD10CM | Covered |
| I82.A21 | ICD10CM | Covered |
| I82.A22 | ICD10CM | Covered |
| I82.A23 | ICD10CM | Covered |
| I82.B11 | ICD10CM | Covered |
| I82.B12 | ICD10CM | Covered |
| I82.B13 | ICD10CM | Covered |
| I82.B21 | ICD10CM | Covered |
| I82.B22 | ICD10CM | Covered |
| I82.B23 | ICD10CM | Covered |
| I82.C11 | ICD10CM | Covered |
| I82.C12 | ICD10CM | Covered |
| I82.C13 | ICD10CM | Covered |
| I82.C21 | ICD10CM | Covered |
| I82.C22 | ICD10CM | Covered |
| I82.C23 | 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 |
| I85.00 | ICD10CM | Covered |
| I85.01 | ICD10CM | Covered |
| I86.4 | ICD10CM | Covered |
| I86.8 | ICD10CM | Covered |
| I87.001 | ICD10CM | Covered |
| I87.002 | ICD10CM | Covered |
| I87.003 | ICD10CM | Covered |
| I87.011 | ICD10CM | Covered |
| I87.012 | ICD10CM | Covered |
| I87.013 | ICD10CM | Covered |
| I87.021 | ICD10CM | Covered |
| I87.022 | ICD10CM | Covered |
| I87.023 | ICD10CM | Covered |
| I87.031 | ICD10CM | Covered |
| I87.032 | ICD10CM | Covered |
| I87.033 | ICD10CM | Covered |
| I87.091 | ICD10CM | Covered |
| I87.092 | ICD10CM | Covered |
| I87.093 | ICD10CM | Covered |
| I87.1 | ICD10CM | Covered |
| I87.2 | ICD10CM | Covered |
| I87.301 | ICD10CM | Covered |
| I87.302 | ICD10CM | Covered |
| I87.303 | ICD10CM | Covered |
| I87.311 | ICD10CM | Covered |
| I87.312 | ICD10CM | Covered |
| I87.313 | ICD10CM | Covered |
| I87.321 | ICD10CM | Covered |
| I87.322 | ICD10CM | Covered |
| I87.323 | ICD10CM | Covered |
| I87.331 | ICD10CM | Covered |
| I87.332 | ICD10CM | Covered |
| I87.333 | ICD10CM | Covered |
| I87.391 | ICD10CM | Covered |
| I87.392 | ICD10CM | Covered |
| I87.393 | ICD10CM | Covered |
| I96 | ICD10CM | Covered |
| I97.410 | ICD10CM | Covered |
| I97.51 | ICD10CM | Covered |
| I97.52 | ICD10CM | Covered |
| I97.610 | ICD10CM | Covered |
| I97.611 | ICD10CM | Covered |
| I97.618 | ICD10CM | Covered |
| I97.810 | ICD10CM | Covered |
| I97.811 | ICD10CM | Covered |
| I97.820 | ICD10CM | Covered |
| I97.821 | ICD10CM | Covered |
| J95.87 | ICD10CM | Covered |
| J96.00 | ICD10CM | Covered |
| J96.01 | ICD10CM | Covered |
| J96.02 | ICD10CM | Covered |
| J96.10 | ICD10CM | Covered |
| J96.11 | ICD10CM | Covered |
| J96.12 | ICD10CM | Covered |
| J96.20 | ICD10CM | Covered |
| J96.21 | ICD10CM | Covered |
| J96.22 | ICD10CM | Covered |
| K55.011 | ICD10CM | Covered |
| K55.012 | ICD10CM | Covered |
| K55.019 | ICD10CM | Covered |
| K55.021 | ICD10CM | Covered |
| K55.022 | ICD10CM | Covered |
| K55.029 | ICD10CM | Covered |
| K55.031 | ICD10CM | Covered |
| K55.032 | ICD10CM | Covered |
| K55.039 | ICD10CM | Covered |
| K55.041 | ICD10CM | Covered |
| K55.042 | ICD10CM | Covered |
| K55.049 | ICD10CM | Covered |
| K55.051 | ICD10CM | Covered |
| K55.052 | ICD10CM | Covered |
| K55.059 | ICD10CM | Covered |
| K55.061 | ICD10CM | Covered |
| K55.062 | ICD10CM | Covered |
| K55.069 | ICD10CM | Covered |
| K55.1 | ICD10CM | Covered |
| K70.2 | ICD10CM | Covered |
| K70.30 | ICD10CM | Covered |
| K70.31 | ICD10CM | Covered |
| K70.41 | ICD10CM | Covered |
| K71.11 | ICD10CM | Covered |
| K72.00 | ICD10CM | Covered |
| K72.01 | ICD10CM | Covered |
| K72.11 | ICD10CM | Covered |
| K74.00 | ICD10CM | Covered |
| K74.01 | ICD10CM | Covered |
| K74.02 | ICD10CM | Covered |
| K74.3 | ICD10CM | Covered |
| K74.4 | ICD10CM | Covered |
| K74.60 | ICD10CM | Covered |
| K74.69 | ICD10CM | Covered |
| K75.1 | ICD10CM | Covered |
| K76.2 | ICD10CM | Covered |
| K76.6 | ICD10CM | Covered |
| K76.7 | ICD10CM | Covered |
| L76.11 | ICD10CM | Covered |
| L76.12 | ICD10CM | Covered |
| L97.111 | 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 |
| L97.119 | ICD10CM | Covered |
| L97.121 | 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 |
| L97.129 | ICD10CM | Covered |
| L97.211 | 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 |
| L97.219 | ICD10CM | Covered |
| L97.221 | 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 |
| L97.311 | 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 |
| L97.319 | ICD10CM | Covered |
| L97.321 | 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 |
| L97.329 | ICD10CM | Covered |
| L97.411 | 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 |
| L97.419 | ICD10CM | Covered |
| L97.421 | 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 |
| L97.429 | ICD10CM | Covered |
| L97.511 | 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 |
| L97.519 | ICD10CM | Covered |
| L97.521 | 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 |
| L97.529 | ICD10CM | Covered |
| L97.811 | 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 |
| L97.819 | ICD10CM | Covered |
| L97.821 | 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 |
| L97.829 | 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 |
| M31.4 | ICD10CM | Covered |
| M31.6 | ICD10CM | Covered |
| M54.2 | ICD10CM | Covered |
| M79.601 | ICD10CM | Covered |
| M79.602 | ICD10CM | Covered |
| M79.604 | ICD10CM | Covered |
| M79.605 | ICD10CM | Covered |
| M79.621 | ICD10CM | Covered |
| M79.622 | ICD10CM | Covered |
| M79.631 | ICD10CM | Covered |
| M79.632 | ICD10CM | Covered |
| M79.641 | ICD10CM | Covered |
| M79.642 | ICD10CM | Covered |
| M79.644 | ICD10CM | Covered |
| M79.645 | ICD10CM | Covered |
| M79.651 | ICD10CM | Covered |
| M79.652 | ICD10CM | Covered |
| M79.661 | ICD10CM | Covered |
| M79.662 | ICD10CM | Covered |
| M79.671 | ICD10CM | Covered |
| M79.672 | ICD10CM | Covered |
| M79.674 | ICD10CM | Covered |
| M79.675 | ICD10CM | Covered |
| M79.89 | ICD10CM | Covered |
| M96.810 | ICD10CM | Covered |
| M96.811 | ICD10CM | Covered |
| M96.820 | ICD10CM | Covered |
| M96.821 | ICD10CM | Covered |
| M96.830 | ICD10CM | Covered |
| M96.831 | ICD10CM | Covered |
| N17.0 | ICD10CM | Covered |
| N17.1 | ICD10CM | Covered |
| N17.2 | ICD10CM | Covered |
| N17.8 | ICD10CM | Covered |
| N18.30 | ICD10CM | Covered |
| N18.31 | ICD10CM | Covered |
| N18.32 | ICD10CM | Covered |
| N18.4 | ICD10CM | Covered |
| N18.5 | ICD10CM | Covered |
| N18.6 | ICD10CM | Covered |
| N26.2 | ICD10CM | Covered |
| N27.0 | ICD10CM | Covered |
| N27.1 | ICD10CM | Covered |
| N28.0 | ICD10CM | Covered |
| N44.01 | ICD10CM | Covered |
| N44.02 | ICD10CM | Covered |
| N44.03 | ICD10CM | Covered |
| N44.04 | ICD10CM | Covered |
| N45.1 | ICD10CM | Covered |
| N45.2 | ICD10CM | Covered |
| N45.3 | ICD10CM | Covered |
| N45.4 | ICD10CM | Covered |
| N50.1 | ICD10CM | Covered |
| N50.811 | ICD10CM | Covered |
| N50.812 | ICD10CM | Covered |
| N50.819 | ICD10CM | Covered |
| N50.82 | ICD10CM | Covered |
| N50.89 | ICD10CM | Covered |
| N50.9 | ICD10CM | Covered |
| N51 | ICD10CM | Covered |
| N52.01 | ICD10CM | Covered |
| N52.02 | ICD10CM | Covered |
| N52.03 | ICD10CM | Covered |
| N52.1 | ICD10CM | Covered |
| N52.2 | ICD10CM | Covered |
| N52.31 | ICD10CM | Covered |
| N52.32 | ICD10CM | Covered |
| N52.33 | ICD10CM | Covered |
| N52.34 | ICD10CM | Covered |
| N52.39 | ICD10CM | Covered |
| N52.8 | ICD10CM | Covered |
| N83.511 | ICD10CM | Covered |
| N83.512 | ICD10CM | Covered |
| N83.519 | ICD10CM | Covered |
| N83.521 | ICD10CM | Covered |
| N83.522 | ICD10CM | Covered |
| N83.529 | ICD10CM | Covered |
| N83.53 | ICD10CM | Covered |
| N83.6 | ICD10CM | Covered |
| N83.8 | ICD10CM | Covered |