About this policy
The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD L34596 Immunizations.
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 3,260 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 90296 | HCPCS | Covered |
| 90476 | HCPCS | Covered |
| 90477 | HCPCS | Covered |
| 90581 | HCPCS | Covered |
| 90585 | HCPCS | Covered |
| 90587 | HCPCS | Covered |
| 90619 | HCPCS | Covered |
| 90620 | HCPCS | Covered |
| 90621 | HCPCS | Covered |
| 90625 | HCPCS | Covered |
| 90632 | HCPCS | Covered |
| 90633 | HCPCS | Covered |
| 90634 | HCPCS | Covered |
| 90636 | HCPCS | Covered |
| 90644 | HCPCS | Covered |
| 90647 | HCPCS | Covered |
| 90648 | HCPCS | Covered |
| 90649 | HCPCS | Covered |
| 90650 | HCPCS | Covered |
| 90651 | HCPCS | Covered |
| 90675 | HCPCS | Covered |
| 90676 | HCPCS | Covered |
| 90680 | HCPCS | Covered |
| 90681 | HCPCS | Covered |
| 90690 | HCPCS | Covered |
| 90691 | HCPCS | Covered |
| 90696 | HCPCS | Covered |
| 90697 | HCPCS | Covered |
| 90698 | HCPCS | Covered |
| 90700 | HCPCS | Covered |
| 90702 | HCPCS | Covered |
| 90707 | HCPCS | Covered |
| 90710 | HCPCS | Covered |
| 90713 | HCPCS | Covered |
| 90714 | HCPCS | Covered |
| 90715 | HCPCS | Covered |
| 90716 | HCPCS | Covered |
| 90717 | HCPCS | Covered |
| 90723 | HCPCS | Covered |
| 90733 | HCPCS | Covered |
| 90734 | HCPCS | Covered |
| 90736 | HCPCS | Covered |
| 90738 | HCPCS | Covered |
| 90748 | HCPCS | Covered |
| 90749 | HCPCS | Covered |
| 90750 | HCPCS | Covered |
| A36.0 | ICD10CM | Covered |
| A36.1 | ICD10CM | Covered |
| A36.2 | ICD10CM | Covered |
| A36.3 | ICD10CM | Covered |
| A36.81 | ICD10CM | Covered |
| A36.82 | ICD10CM | Covered |
| A36.83 | ICD10CM | Covered |
| A36.84 | ICD10CM | Covered |
| A36.85 | ICD10CM | Covered |
| A36.86 | ICD10CM | Covered |
| A36.89 | ICD10CM | Covered |
| A36.9 | ICD10CM | Covered |
| A82.0 | ICD10CM | Covered |
| A82.1 | ICD10CM | Covered |
| A82.9 | ICD10CM | Covered |
| S00.01XA | ICD10CM | Covered |
| S00.02XA | ICD10CM | Covered |
| S00.04XA | ICD10CM | Covered |
| S00.05XA | ICD10CM | Covered |
| S00.06XA | ICD10CM | Covered |
| S00.07XA | ICD10CM | Covered |
| S00.201A | ICD10CM | Covered |
| S00.202A | ICD10CM | Covered |
| S00.211A | ICD10CM | Covered |
| S00.212A | ICD10CM | Covered |
| S00.221A | ICD10CM | Covered |
| S00.222A | ICD10CM | Covered |
| S00.241A | ICD10CM | Covered |
| S00.242A | ICD10CM | Covered |
| S00.251A | ICD10CM | Covered |
| S00.252A | ICD10CM | Covered |
| S00.261A | ICD10CM | Covered |
| S00.262A | ICD10CM | Covered |
| S00.271A | ICD10CM | Covered |
| S00.272A | ICD10CM | Covered |
| S00.31XA | ICD10CM | Covered |
| S00.32XA | ICD10CM | Covered |
| S00.34XA | ICD10CM | Covered |
| S00.35XA | ICD10CM | Covered |
| S00.36XA | ICD10CM | Covered |
| S00.37XA | ICD10CM | Covered |
| S00.411A | ICD10CM | Covered |
| S00.412A | ICD10CM | Covered |
| S00.421A | ICD10CM | Covered |
| S00.422A | ICD10CM | Covered |
| S00.441A | ICD10CM | Covered |
| S00.442A | ICD10CM | Covered |
| S00.451A | ICD10CM | Covered |
| S00.452A | ICD10CM | Covered |
| S00.461A | ICD10CM | Covered |
| S00.462A | ICD10CM | Covered |
| S00.471A | ICD10CM | Covered |
| S00.472A | ICD10CM | Covered |
| S00.511A | ICD10CM | Covered |
| S00.512A | ICD10CM | Covered |
| S00.521A | ICD10CM | Covered |
| S00.522A | ICD10CM | Covered |
| S00.541A | ICD10CM | Covered |
| S00.542A | ICD10CM | Covered |
| S00.551A | ICD10CM | Covered |
| S00.552A | ICD10CM | Covered |
| S00.561A | ICD10CM | Covered |
| S00.562A | ICD10CM | Covered |
| S00.571A | ICD10CM | Covered |
| S00.572A | ICD10CM | Covered |
| S00.81XA | ICD10CM | Covered |
| S00.82XA | ICD10CM | Covered |
| S00.84XA | ICD10CM | Covered |
| S00.85XA | ICD10CM | Covered |
| S00.86XA | ICD10CM | Covered |
| S00.87XA | ICD10CM | Covered |
| S01.01XA | ICD10CM | Covered |
| S01.02XA | ICD10CM | Covered |
| S01.03XA | ICD10CM | Covered |
| S01.04XA | ICD10CM | Covered |
| S01.05XA | ICD10CM | Covered |
| S01.101A | ICD10CM | Covered |
| S01.102A | ICD10CM | Covered |
| S01.111A | ICD10CM | Covered |
| S01.112A | ICD10CM | Covered |
| S01.121A | ICD10CM | Covered |
| S01.122A | ICD10CM | Covered |
| S01.131A | ICD10CM | Covered |
| S01.132A | ICD10CM | Covered |
| S01.141A | ICD10CM | Covered |
| S01.142A | ICD10CM | Covered |
| S01.151A | ICD10CM | Covered |
| S01.152A | ICD10CM | Covered |
| S01.21XA | ICD10CM | Covered |
| S01.22XA | ICD10CM | Covered |
| S01.23XA | ICD10CM | Covered |
| S01.24XA | ICD10CM | Covered |
| S01.25XA | ICD10CM | Covered |
| S01.301A | ICD10CM | Covered |
| S01.302A | ICD10CM | Covered |
| S01.311A | ICD10CM | Covered |
| S01.312A | ICD10CM | Covered |
| S01.321A | ICD10CM | Covered |
| S01.322A | ICD10CM | Covered |
| S01.331A | ICD10CM | Covered |
| S01.332A | ICD10CM | Covered |
| S01.341A | ICD10CM | Covered |
| S01.342A | ICD10CM | Covered |
| S01.351A | ICD10CM | Covered |
| S01.352A | ICD10CM | Covered |
| S01.411A | ICD10CM | Covered |
| S01.412A | ICD10CM | Covered |
| S01.421A | ICD10CM | Covered |
| S01.422A | ICD10CM | Covered |
| S01.431A | ICD10CM | Covered |
| S01.432A | ICD10CM | Covered |
| S01.441A | ICD10CM | Covered |
| S01.442A | ICD10CM | Covered |
| S01.451A | ICD10CM | Covered |
| S01.452A | ICD10CM | Covered |
| S01.511A | ICD10CM | Covered |
| S01.512A | ICD10CM | Covered |
| S01.521A | ICD10CM | Covered |
| S01.522A | ICD10CM | Covered |
| S01.531A | ICD10CM | Covered |
| S01.532A | ICD10CM | Covered |
| S01.541A | ICD10CM | Covered |
| S01.542A | ICD10CM | Covered |
| S01.551A | ICD10CM | Covered |
| S01.552A | ICD10CM | Covered |
| S01.81XA | ICD10CM | Covered |
| S01.82XA | ICD10CM | Covered |
| S01.83XA | ICD10CM | Covered |
| S01.84XA | ICD10CM | Covered |
| S01.85XA | ICD10CM | Covered |
| S02.0XXB | ICD10CM | Covered |
| S02.101B | ICD10CM | Covered |
| S02.102B | ICD10CM | Covered |
| S02.11AB | ICD10CM | Covered |
| S02.11BB | ICD10CM | Covered |
| S02.11CB | ICD10CM | Covered |
| S02.11DB | ICD10CM | Covered |
| S02.11EB | ICD10CM | Covered |
| S02.11FB | ICD10CM | Covered |
| S02.11GB | ICD10CM | Covered |
| S02.11HB | ICD10CM | Covered |
| S02.121B | ICD10CM | Covered |
| S02.122B | ICD10CM | Covered |
| S02.19XB | ICD10CM | Covered |
| S02.2XXB | ICD10CM | Covered |
| S02.31XB | ICD10CM | Covered |
| S02.32XB | ICD10CM | Covered |
| S02.40AB | ICD10CM | Covered |
| S02.40BB | ICD10CM | Covered |
| S02.40CB | ICD10CM | Covered |
| S02.40DB | ICD10CM | Covered |
| S02.40EB | ICD10CM | Covered |
| S02.40FB | ICD10CM | Covered |
| S02.411B | ICD10CM | Covered |
| S02.412B | ICD10CM | Covered |
| S02.413B | ICD10CM | Covered |
| S02.42XB | ICD10CM | Covered |
| S02.5XXA | ICD10CM | Covered |
| S02.5XXB | ICD10CM | Covered |
| S02.611B | ICD10CM | Covered |
| S02.612B | ICD10CM | Covered |
| S02.621B | ICD10CM | Covered |
| S02.622B | ICD10CM | Covered |
| S02.631B | ICD10CM | Covered |
| S02.632B | ICD10CM | Covered |
| S02.641B | ICD10CM | Covered |
| S02.642B | ICD10CM | Covered |
| S02.651B | ICD10CM | Covered |
| S02.652B | ICD10CM | Covered |
| S02.66XB | ICD10CM | Covered |
| S02.671B | ICD10CM | Covered |
| S02.672B | ICD10CM | Covered |
| S02.69XB | ICD10CM | Covered |
| S02.81XB | ICD10CM | Covered |
| S02.82XB | ICD10CM | Covered |
| S02.831B | ICD10CM | Covered |
| S02.832B | ICD10CM | Covered |
| S02.841B | ICD10CM | Covered |
| S02.842B | ICD10CM | Covered |
| S03.2XXA | ICD10CM | Covered |
| S05.01XA | ICD10CM | Covered |
| S05.02XA | ICD10CM | Covered |
| S05.21XA | ICD10CM | Covered |
| S05.22XA | ICD10CM | Covered |
| S05.31XA | ICD10CM | Covered |
| S05.32XA | ICD10CM | Covered |
| S05.41XA | ICD10CM | Covered |
| S05.42XA | ICD10CM | Covered |
| S05.51XA | ICD10CM | Covered |
| S05.52XA | ICD10CM | Covered |
| S05.61XA | ICD10CM | Covered |
| S05.62XA | ICD10CM | Covered |
| S05.71XA | ICD10CM | Covered |
| S05.72XA | ICD10CM | Covered |
| S05.8X1A | ICD10CM | Covered |
| S05.8X2A | ICD10CM | Covered |
| S08.0XXA | ICD10CM | Covered |
| S08.111A | ICD10CM | Covered |
| S08.112A | ICD10CM | Covered |
| S08.121A | ICD10CM | Covered |
| S08.122A | ICD10CM | Covered |
| S08.811A | ICD10CM | Covered |
| S08.812A | ICD10CM | Covered |
| S08.89XA | ICD10CM | Covered |
| S09.12XA | ICD10CM | Covered |
| S09.21XA | ICD10CM | Covered |
| S09.22XA | ICD10CM | Covered |
| S09.301A | ICD10CM | Covered |
| S09.302A | ICD10CM | Covered |
| S09.311A | ICD10CM | Covered |
| S09.312A | ICD10CM | Covered |
| S09.313A | ICD10CM | Covered |
| S09.391A | ICD10CM | Covered |
| S09.392A | ICD10CM | Covered |
| S09.8XXA | ICD10CM | Covered |
| S09.93XA | ICD10CM | Covered |
| S10.11XA | ICD10CM | Covered |
| S10.12XA | ICD10CM | Covered |
| S10.14XA | ICD10CM | Covered |
| S10.15XA | ICD10CM | Covered |
| S10.16XA | ICD10CM | Covered |
| S10.17XA | ICD10CM | Covered |
| S10.81XA | ICD10CM | Covered |
| S10.82XA | ICD10CM | Covered |
| S10.84XA | ICD10CM | Covered |
| S10.85XA | ICD10CM | Covered |
| S10.86XA | ICD10CM | Covered |
| S10.87XA | ICD10CM | Covered |
| S10.97XA | ICD10CM | Covered |
| S11.011A | ICD10CM | Covered |
| S11.012A | ICD10CM | Covered |
| S11.013A | ICD10CM | Covered |
| S11.014A | ICD10CM | Covered |
| S11.015A | ICD10CM | Covered |
| S11.021A | ICD10CM | Covered |
| S11.022A | ICD10CM | Covered |
| S11.023A | ICD10CM | Covered |
| S11.024A | ICD10CM | Covered |
| S11.025A | ICD10CM | Covered |
| S11.031A | ICD10CM | Covered |
| S11.032A | ICD10CM | Covered |
| S11.033A | ICD10CM | Covered |
| S11.034A | ICD10CM | Covered |
| S11.035A | ICD10CM | Covered |
| S11.11XA | ICD10CM | Covered |
| S11.12XA | ICD10CM | Covered |
| S11.13XA | ICD10CM | Covered |
| S11.14XA | ICD10CM | Covered |
| S11.15XA | ICD10CM | Covered |
| S11.21XA | ICD10CM | Covered |
| S11.22XA | ICD10CM | Covered |
| S11.23XA | ICD10CM | Covered |
| S11.24XA | ICD10CM | Covered |
| S11.25XA | ICD10CM | Covered |
| S11.81XA | ICD10CM | Covered |
| S11.82XA | ICD10CM | Covered |
| S11.83XA | ICD10CM | Covered |
| S11.84XA | ICD10CM | Covered |
| S11.85XA | ICD10CM | Covered |
| S11.89XA | ICD10CM | Covered |
| S12.01XB | ICD10CM | Covered |
| S12.02XB | ICD10CM | Covered |
| S12.030B | ICD10CM | Covered |
| S12.031B | ICD10CM | Covered |
| S12.040B | ICD10CM | Covered |
| S12.041B | ICD10CM | Covered |
| S12.090B | ICD10CM | Covered |
| S12.091B | ICD10CM | Covered |
| S12.110B | ICD10CM | Covered |
| S12.111B | ICD10CM | Covered |
| S12.112B | ICD10CM | Covered |
| S12.120B | ICD10CM | Covered |
| S12.121B | ICD10CM | Covered |
| S12.14XB | ICD10CM | Covered |
| S12.150B | ICD10CM | Covered |
| S12.151B | ICD10CM | Covered |
| S12.190B | ICD10CM | Covered |
| S12.191B | ICD10CM | Covered |
| S12.24XB | ICD10CM | Covered |
| S12.250B | ICD10CM | Covered |
| S12.251B | ICD10CM | Covered |
| S12.290B | ICD10CM | Covered |
| S12.291B | ICD10CM | Covered |
| S12.34XB | ICD10CM | Covered |
| S12.350B | ICD10CM | Covered |
| S12.351B | ICD10CM | Covered |
| S12.390B | ICD10CM | Covered |
| S12.391B | ICD10CM | Covered |
| S12.44XB | ICD10CM | Covered |
| S12.450B | ICD10CM | Covered |
| S12.451B | ICD10CM | Covered |
| S12.490B | ICD10CM | Covered |
| S12.491B | ICD10CM | Covered |
| S12.54XB | ICD10CM | Covered |
| S12.550B | ICD10CM | Covered |
| S12.551B | ICD10CM | Covered |
| S12.590B | ICD10CM | Covered |
| S12.591B | ICD10CM | Covered |
| S12.64XB | ICD10CM | Covered |
| S12.650B | ICD10CM | Covered |
| S12.651B | ICD10CM | Covered |
| S12.690B | ICD10CM | Covered |
| S12.691B | ICD10CM | Covered |
| S16.2XXA | ICD10CM | Covered |
| S20.111A | ICD10CM | Covered |
| S20.112A | ICD10CM | Covered |
| S20.121A | ICD10CM | Covered |
| S20.122A | ICD10CM | Covered |
| S20.141A | ICD10CM | Covered |
| S20.142A | ICD10CM | Covered |
| S20.151A | ICD10CM | Covered |
| S20.152A | ICD10CM | Covered |
| S20.161A | ICD10CM | Covered |
| S20.162A | ICD10CM | Covered |
| S20.171A | ICD10CM | Covered |
| S20.172A | ICD10CM | Covered |
| S20.303A | ICD10CM | Covered |
| S20.303D | ICD10CM | Covered |
| S20.303S | ICD10CM | Covered |
| S20.304A | ICD10CM | Covered |
| S20.304D | ICD10CM | Covered |
| S20.304S | ICD10CM | Covered |
| S20.311A | ICD10CM | Covered |
| S20.312A | ICD10CM | Covered |
| S20.313A | ICD10CM | Covered |
| S20.313D | ICD10CM | Covered |
| S20.313S | ICD10CM | Covered |
| S20.314A | ICD10CM | Covered |
| S20.314D | ICD10CM | Covered |
| S20.314S | ICD10CM | Covered |
| S20.321A | ICD10CM | Covered |
| S20.322A | ICD10CM | Covered |
| S20.323A | ICD10CM | Covered |
| S20.323D | ICD10CM | Covered |
| S20.323S | ICD10CM | Covered |
| S20.324A | ICD10CM | Covered |
| S20.324D | ICD10CM | Covered |
| S20.324S | ICD10CM | Covered |
| S20.341A | ICD10CM | Covered |
| S20.342A | ICD10CM | Covered |
| S20.343A | ICD10CM | Covered |
| S20.343D | ICD10CM | Covered |
| S20.343S | ICD10CM | Covered |
| S20.344A | ICD10CM | Covered |
| S20.344D | ICD10CM | Covered |
| S20.344S | ICD10CM | Covered |
| S20.351A | ICD10CM | Covered |
| S20.352A | ICD10CM | Covered |
| S20.353A | ICD10CM | Covered |
| S20.353D | ICD10CM | Covered |
| S20.353S | ICD10CM | Covered |
| S20.354A | ICD10CM | Covered |
| S20.354D | ICD10CM | Covered |
| S20.354S | ICD10CM | Covered |
| S20.361A | ICD10CM | Covered |
| S20.362A | ICD10CM | Covered |
| S20.363A | ICD10CM | Covered |
| S20.363D | ICD10CM | Covered |
| S20.363S | ICD10CM | Covered |
| S20.364A | ICD10CM | Covered |
| S20.364D | ICD10CM | Covered |
| S20.364S | ICD10CM | Covered |
| S20.371A | ICD10CM | Covered |
| S20.372A | ICD10CM | Covered |
| S20.373A | ICD10CM | Covered |
| S20.373D | ICD10CM | Covered |
| S20.373S | ICD10CM | Covered |
| S20.374A | ICD10CM | Covered |
| S20.374D | ICD10CM | Covered |
| S20.374S | ICD10CM | Covered |
| S20.411A | ICD10CM | Covered |
| S20.412A | ICD10CM | Covered |
| S20.421A | ICD10CM | Covered |
| S20.422A | ICD10CM | Covered |
| S20.441A | ICD10CM | Covered |
| S20.442A | ICD10CM | Covered |
| S20.451A | ICD10CM | Covered |
| S20.452A | ICD10CM | Covered |
| S20.461A | ICD10CM | Covered |
| S20.462A | ICD10CM | Covered |
| S20.471A | ICD10CM | Covered |
| S20.472A | ICD10CM | Covered |
| S21.011A | ICD10CM | Covered |
| S21.012A | ICD10CM | Covered |
| S21.021A | ICD10CM | Covered |
| S21.022A | ICD10CM | Covered |
| S21.031A | ICD10CM | Covered |
| S21.032A | ICD10CM | Covered |
| S21.041A | ICD10CM | Covered |
| S21.042A | ICD10CM | Covered |
| S21.051A | ICD10CM | Covered |
| S21.052A | ICD10CM | Covered |
| S21.111A | ICD10CM | Covered |
| S21.112A | ICD10CM | Covered |
| S21.121A | ICD10CM | Covered |
| S21.122A | ICD10CM | Covered |
| S21.131A | ICD10CM | Covered |
| S21.132A | ICD10CM | Covered |
| S21.141A | ICD10CM | Covered |
| S21.142A | ICD10CM | Covered |
| S21.151A | ICD10CM | Covered |
| S21.152A | ICD10CM | Covered |
| S21.211A | ICD10CM | Covered |
| S21.212A | ICD10CM | Covered |
| S21.221A | ICD10CM | Covered |
| S21.222A | ICD10CM | Covered |
| S21.231A | ICD10CM | Covered |
| S21.232A | ICD10CM | Covered |
| S21.241A | ICD10CM | Covered |
| S21.242A | ICD10CM | Covered |
| S21.251A | ICD10CM | Covered |
| S21.252A | ICD10CM | Covered |
| S22.010B | ICD10CM | Covered |
| S22.011B | ICD10CM | Covered |
| S22.012B | ICD10CM | Covered |
| S22.018B | ICD10CM | Covered |
| S22.020B | ICD10CM | Covered |
| S22.021B | ICD10CM | Covered |
| S22.022B | ICD10CM | Covered |
| S22.028B | ICD10CM | Covered |
| S22.030B | ICD10CM | Covered |
| S22.031B | ICD10CM | Covered |
| S22.032B | ICD10CM | Covered |
| S22.038B | ICD10CM | Covered |
| S22.040B | ICD10CM | Covered |
| S22.041B | ICD10CM | Covered |
| S22.042B | ICD10CM | Covered |
| S22.048B | ICD10CM | Covered |
| S22.050B | ICD10CM | Covered |
| S22.051B | ICD10CM | Covered |
| S22.052B | ICD10CM | Covered |
| S22.058B | ICD10CM | Covered |
| S22.060B | ICD10CM | Covered |
| S22.061B | ICD10CM | Covered |
| S22.062B | ICD10CM | Covered |
| S22.068B | ICD10CM | Covered |
| S22.070B | ICD10CM | Covered |
| S22.071B | ICD10CM | Covered |
| S22.072B | ICD10CM | Covered |
| S22.078B | ICD10CM | Covered |
| S22.080B | ICD10CM | Covered |
| S22.081B | ICD10CM | Covered |
| S22.082B | ICD10CM | Covered |
| S22.088B | ICD10CM | Covered |
| S22.21XB | ICD10CM | Covered |
| S22.22XB | ICD10CM | Covered |
| S22.23XB | ICD10CM | Covered |
| S22.24XB | ICD10CM | Covered |
| S22.31XB | ICD10CM | Covered |
| S22.32XB | ICD10CM | Covered |
| S22.41XB | ICD10CM | Covered |
| S22.42XB | ICD10CM | Covered |
| S22.43XB | ICD10CM | Covered |
| S22.5XXB | ICD10CM | Covered |
| S28.1XXA | ICD10CM | Covered |
| S28.211A | ICD10CM | Covered |
| S28.212A | ICD10CM | Covered |
| S28.221A | ICD10CM | Covered |
| S28.222A | ICD10CM | Covered |
| S29.021A | ICD10CM | Covered |
| S29.022A | ICD10CM | Covered |
| S30.810A | ICD10CM | Covered |
| S30.811A | ICD10CM | Covered |
| S30.812A | ICD10CM | Covered |
| S30.813A | ICD10CM | Covered |
| S30.814A | ICD10CM | Covered |
| S30.817A | ICD10CM | Covered |
| S30.81AA | ICD10CM | Covered |
| S30.81AD | ICD10CM | Covered |
| S30.81AS | ICD10CM | Covered |
| S30.820A | ICD10CM | Covered |
| S30.821A | ICD10CM | Covered |
| S30.822A | ICD10CM | Covered |
| S30.823A | ICD10CM | Covered |
| S30.824A | ICD10CM | Covered |
| S30.827A | ICD10CM | Covered |
| S30.82AA | ICD10CM | Covered |
| S30.82AD | ICD10CM | Covered |
| S30.82AS | ICD10CM | Covered |
| S30.840A | ICD10CM | Covered |
| S30.841A | ICD10CM | Covered |
| S30.842A | ICD10CM | Covered |
| S30.843A | ICD10CM | Covered |
| S30.844A | ICD10CM | Covered |
| S30.84AA | ICD10CM | Covered |
| S30.84AD | ICD10CM | Covered |
| S30.84AS | ICD10CM | Covered |
| S30.850A | ICD10CM | Covered |
| S30.851A | ICD10CM | Covered |
| S30.852A | ICD10CM | Covered |
| S30.853A | ICD10CM | Covered |
| S30.854A | ICD10CM | Covered |
| S30.857A | ICD10CM | Covered |
| S30.85AA | ICD10CM | Covered |
| S30.85AD | ICD10CM | Covered |
| S30.85AS | ICD10CM | Covered |
| S30.860A | ICD10CM | Covered |
| S30.861A | ICD10CM | Covered |
| S30.862A | ICD10CM | Covered |
| S30.863A | ICD10CM | Covered |
| S30.864A | ICD10CM | Covered |
| S30.867A | ICD10CM | Covered |
| S30.86AA | ICD10CM | Covered |
| S30.86AD | ICD10CM | Covered |
| S30.86AS | ICD10CM | Covered |
| S30.870A | ICD10CM | Covered |
| S30.871A | ICD10CM | Covered |
| S30.872A | ICD10CM | Covered |
| S30.873A | ICD10CM | Covered |
| S30.874A | ICD10CM | Covered |
| S30.877A | ICD10CM | Covered |
| S30.87AA | ICD10CM | Covered |
| S30.87AD | ICD10CM | Covered |
| S30.87AS | ICD10CM | Covered |
| S31.010A | ICD10CM | Covered |
| S31.020A | ICD10CM | Covered |
| S31.030A | ICD10CM | Covered |
| S31.040A | ICD10CM | Covered |
| S31.050A | ICD10CM | Covered |
| S31.106A | ICD10CM | Covered |
| S31.106D | ICD10CM | Covered |
| S31.106S | ICD10CM | Covered |
| S31.107A | ICD10CM | Covered |
| S31.107D | ICD10CM | Covered |
| S31.107S | ICD10CM | Covered |
| S31.10AA | ICD10CM | Covered |
| S31.10AD | ICD10CM | Covered |
| S31.10AS | ICD10CM | Covered |
| S31.110A | ICD10CM | Covered |
| S31.111A | ICD10CM | Covered |
| S31.112A | ICD10CM | Covered |
| S31.113A | ICD10CM | Covered |
| S31.114A | ICD10CM | Covered |
| S31.115A | ICD10CM | Covered |
| S31.116A | ICD10CM | Covered |
| S31.116D | ICD10CM | Covered |
| S31.116S | ICD10CM | Covered |
| S31.117A | ICD10CM | Covered |
| S31.117D | ICD10CM | Covered |
| S31.117S | ICD10CM | Covered |
| S31.11AA | ICD10CM | Covered |
| S31.11AD | ICD10CM | Covered |
| S31.11AS | ICD10CM | Covered |
| S31.120A | ICD10CM | Covered |
| S31.121A | ICD10CM | Covered |
| S31.122A | ICD10CM | Covered |
| S31.123A | ICD10CM | Covered |
| S31.124A | ICD10CM | Covered |
| S31.125A | ICD10CM | Covered |
| S31.126A | ICD10CM | Covered |
| S31.126D | ICD10CM | Covered |
| S31.126S | ICD10CM | Covered |
| S31.127A | ICD10CM | Covered |
| S31.127D | ICD10CM | Covered |
| S31.127S | ICD10CM | Covered |
| S31.12AA | ICD10CM | Covered |
| S31.12AD | ICD10CM | Covered |
| S31.12AS | ICD10CM | Covered |
| S31.130A | ICD10CM | Covered |
| S31.131A | ICD10CM | Covered |
| S31.132A | ICD10CM | Covered |
| S31.133A | ICD10CM | Covered |
| S31.134A | ICD10CM | Covered |
| S31.135A | ICD10CM | Covered |
| S31.136A | ICD10CM | Covered |
| S31.136D | ICD10CM | Covered |
| S31.136S | ICD10CM | Covered |
| S31.137A | ICD10CM | Covered |
| S31.137D | ICD10CM | Covered |
| S31.137S | ICD10CM | Covered |
| S31.13AA | ICD10CM | Covered |
| S31.13AD | ICD10CM | Covered |
| S31.13AS | ICD10CM | Covered |
| S31.140A | ICD10CM | Covered |
| S31.141A | ICD10CM | Covered |
| S31.142A | ICD10CM | Covered |
| S31.143A | ICD10CM | Covered |
| S31.144A | ICD10CM | Covered |
| S31.145A | ICD10CM | Covered |
| S31.146A | ICD10CM | Covered |
| S31.146D | ICD10CM | Covered |
| S31.146S | ICD10CM | Covered |
| S31.147A | ICD10CM | Covered |
| S31.147D | ICD10CM | Covered |
| S31.147S | ICD10CM | Covered |
| S31.14AA | ICD10CM | Covered |
| S31.14AD | ICD10CM | Covered |
| S31.14AS | ICD10CM | Covered |
| S31.150A | ICD10CM | Covered |
| S31.151A | ICD10CM | Covered |
| S31.152A | ICD10CM | Covered |
| S31.153A | ICD10CM | Covered |
| S31.154A | ICD10CM | Covered |
| S31.155A | ICD10CM | Covered |
| S31.156A | ICD10CM | Covered |
| S31.156D | ICD10CM | Covered |
| S31.156S | ICD10CM | Covered |
| S31.157A | ICD10CM | Covered |
| S31.157D | ICD10CM | Covered |
| S31.157S | ICD10CM | Covered |
| S31.15AA | ICD10CM | Covered |
| S31.15AD | ICD10CM | Covered |
| S31.15AS | ICD10CM | Covered |
| S31.21XA | ICD10CM | Covered |
| S31.22XA | ICD10CM | Covered |
| S31.23XA | ICD10CM | Covered |
| S31.24XA | ICD10CM | Covered |
| S31.25XA | ICD10CM | Covered |
| S31.31XA | ICD10CM | Covered |
| S31.32XA | ICD10CM | Covered |
| S31.33XA | ICD10CM | Covered |
| S31.34XA | ICD10CM | Covered |
| S31.35XA | ICD10CM | Covered |
| S31.41XA | ICD10CM | Covered |
| S31.42XA | ICD10CM | Covered |
| S31.43XA | ICD10CM | Covered |
| S31.44XA | ICD10CM | Covered |
| S31.45XA | ICD10CM | Covered |
| S31.811A | ICD10CM | Covered |
| S31.812A | ICD10CM | Covered |
| S31.813A | ICD10CM | Covered |
| S31.814A | ICD10CM | Covered |
| S31.815A | ICD10CM | Covered |
| S31.821A | ICD10CM | Covered |
| S31.822A | ICD10CM | Covered |
| S31.823A | ICD10CM | Covered |
| S31.824A | ICD10CM | Covered |
| S31.825A | ICD10CM | Covered |
| S31.831A | ICD10CM | Covered |
| S31.832A | ICD10CM | Covered |
| S31.833A | ICD10CM | Covered |
| S31.834A | ICD10CM | Covered |
| S31.835A | ICD10CM | Covered |
| S32.010B | ICD10CM | Covered |
| S32.011B | ICD10CM | Covered |
| S32.012B | ICD10CM | Covered |
| S32.018B | ICD10CM | Covered |
| S32.020B | ICD10CM | Covered |
| S32.021B | ICD10CM | Covered |
| S32.022B | ICD10CM | Covered |
| S32.028B | ICD10CM | Covered |
| S32.030B | ICD10CM | Covered |
| S32.031B | ICD10CM | Covered |
| S32.032B | ICD10CM | Covered |
| S32.038B | ICD10CM | Covered |
| S32.040B | ICD10CM | Covered |
| S32.041B | ICD10CM | Covered |
| S32.042B | ICD10CM | Covered |
| S32.048B | ICD10CM | Covered |
| S32.050B | ICD10CM | Covered |
| S32.051B | ICD10CM | Covered |
| S32.052B | ICD10CM | Covered |
| S32.058B | ICD10CM | Covered |
| S32.110B | ICD10CM | Covered |
| S32.111B | ICD10CM | Covered |
| S32.112B | ICD10CM | Covered |
| S32.120B | ICD10CM | Covered |
| S32.121B | ICD10CM | Covered |
| S32.122B | ICD10CM | Covered |
| S32.130B | ICD10CM | Covered |
| S32.131B | ICD10CM | Covered |
| S32.132B | ICD10CM | Covered |
| S32.14XB | ICD10CM | Covered |
| S32.15XB | ICD10CM | Covered |
| S32.16XB | ICD10CM | Covered |
| S32.17XB | ICD10CM | Covered |
| S32.19XB | ICD10CM | Covered |
| S32.2XXB | ICD10CM | Covered |
| S32.311B | ICD10CM | Covered |
| S32.312B | ICD10CM | Covered |
| S32.314B | ICD10CM | Covered |
| S32.315B | ICD10CM | Covered |
| S32.391B | ICD10CM | Covered |
| S32.392B | ICD10CM | Covered |
| S32.411B | ICD10CM | Covered |
| S32.412B | ICD10CM | Covered |
| S32.414B | ICD10CM | Covered |
| S32.415B | ICD10CM | Covered |
| S32.421B | ICD10CM | Covered |
| S32.422B | ICD10CM | Covered |
| S32.424B | ICD10CM | Covered |
| S32.425B | ICD10CM | Covered |
| S32.431B | ICD10CM | Covered |
| S32.432B | ICD10CM | Covered |
| S32.434B | ICD10CM | Covered |
| S32.435B | ICD10CM | Covered |
| S32.441B | ICD10CM | Covered |
| S32.442B | ICD10CM | Covered |
| S32.444B | ICD10CM | Covered |
| S32.445B | ICD10CM | Covered |
| S32.451B | ICD10CM | Covered |
| S32.452B | ICD10CM | Covered |
| S32.454B | ICD10CM | Covered |
| S32.455B | ICD10CM | Covered |
| S32.461B | ICD10CM | Covered |
| S32.462B | ICD10CM | Covered |
| S32.464B | ICD10CM | Covered |
| S32.465B | ICD10CM | Covered |
| S32.471B | ICD10CM | Covered |
| S32.472B | ICD10CM | Covered |
| S32.474B | ICD10CM | Covered |
| S32.475B | ICD10CM | Covered |
| S32.481B | ICD10CM | Covered |
| S32.482B | ICD10CM | Covered |
| S32.484B | ICD10CM | Covered |
| S32.485B | ICD10CM | Covered |
| S32.491B | ICD10CM | Covered |
| S32.492B | ICD10CM | Covered |
| S32.511B | ICD10CM | Covered |
| S32.512B | ICD10CM | Covered |
| S32.591B | ICD10CM | Covered |
| S32.592B | ICD10CM | Covered |
| S32.611B | ICD10CM | Covered |
| S32.612B | ICD10CM | Covered |
| S32.614B | ICD10CM | Covered |
| S32.615B | ICD10CM | Covered |
| S32.691B | ICD10CM | Covered |
| S32.692B | ICD10CM | Covered |
| S32.810B | ICD10CM | Covered |
| S32.811B | ICD10CM | Covered |
| S32.82XB | ICD10CM | Covered |
| S32.89XB | ICD10CM | Covered |
| S38.211A | ICD10CM | Covered |
| S38.212A | ICD10CM | Covered |
| S38.221A | ICD10CM | Covered |
| S38.222A | ICD10CM | Covered |
| S38.231A | ICD10CM | Covered |
| S38.232A | ICD10CM | Covered |
| S38.3XXA | ICD10CM | Covered |
| S39.021A | ICD10CM | Covered |
| S39.022A | ICD10CM | Covered |
| S39.023A | ICD10CM | Covered |
| S40.211A | ICD10CM | Covered |
| S40.212A | ICD10CM | Covered |
| S40.221A | ICD10CM | Covered |
| S40.222A | ICD10CM | Covered |
| S40.241A | ICD10CM | Covered |
| S40.242A | ICD10CM | Covered |
| S40.251A | ICD10CM | Covered |
| S40.252A | ICD10CM | Covered |
| S40.261A | ICD10CM | Covered |
| S40.262A | ICD10CM | Covered |
| S40.271A | ICD10CM | Covered |
| S40.272A | ICD10CM | Covered |
| S40.811A | ICD10CM | Covered |
| S40.812A | ICD10CM | Covered |
| S40.821A | ICD10CM | Covered |
| S40.822A | ICD10CM | Covered |
| S40.841A | ICD10CM | Covered |
| S40.842A | ICD10CM | Covered |
| S40.851A | ICD10CM | Covered |
| S40.852A | ICD10CM | Covered |
| S40.861A | ICD10CM | Covered |
| S40.862A | ICD10CM | Covered |
| S40.871A | ICD10CM | Covered |
| S40.872A | ICD10CM | Covered |
| S40.911A | ICD10CM | Covered |
| S40.912A | ICD10CM | Covered |
| S40.921A | ICD10CM | Covered |
| S40.922A | ICD10CM | Covered |
| S41.011A | ICD10CM | Covered |
| S41.012A | ICD10CM | Covered |
| S41.021A | ICD10CM | Covered |
| S41.022A | ICD10CM | Covered |
| S41.031A | ICD10CM | Covered |
| S41.032A | ICD10CM | Covered |
| S41.041A | ICD10CM | Covered |
| S41.042A | ICD10CM | Covered |
| S41.051A | ICD10CM | Covered |
| S41.052A | ICD10CM | Covered |
| S41.111A | ICD10CM | Covered |
| S41.112A | ICD10CM | Covered |
| S41.121A | ICD10CM | Covered |
| S41.122A | ICD10CM | Covered |
| S41.131A | ICD10CM | Covered |
| S41.132A | ICD10CM | Covered |
| S41.141A | ICD10CM | Covered |
| S41.142A | ICD10CM | Covered |
| S41.151A | ICD10CM | Covered |
| S41.152A | ICD10CM | Covered |
| S42.011B | ICD10CM | Covered |
| S42.012B | ICD10CM | Covered |
| S42.014B | ICD10CM | Covered |
| S42.015B | ICD10CM | Covered |
| S42.017B | ICD10CM | Covered |
| S42.018B | ICD10CM | Covered |
| S42.021B | ICD10CM | Covered |
| S42.022B | ICD10CM | Covered |
| S42.024B | ICD10CM | Covered |
| S42.025B | ICD10CM | Covered |
| S42.031B | ICD10CM | Covered |
| S42.032B | ICD10CM | Covered |
| S42.034B | ICD10CM | Covered |
| S42.035B | ICD10CM | Covered |
| S42.111B | ICD10CM | Covered |
| S42.112B | ICD10CM | Covered |
| S42.114B | ICD10CM | Covered |
| S42.115B | ICD10CM | Covered |
| S42.121B | ICD10CM | Covered |
| S42.122B | ICD10CM | Covered |
| S42.124B | ICD10CM | Covered |
| S42.125B | ICD10CM | Covered |
| S42.131B | ICD10CM | Covered |
| S42.132B | ICD10CM | Covered |
| S42.135B | ICD10CM | Covered |
| S42.141B | ICD10CM | Covered |
| S42.142B | ICD10CM | Covered |
| S42.144B | ICD10CM | Covered |
| S42.145B | ICD10CM | Covered |
| S42.151B | ICD10CM | Covered |
| S42.152B | ICD10CM | Covered |
| S42.154B | ICD10CM | Covered |
| S42.155B | ICD10CM | Covered |
| S42.191B | ICD10CM | Covered |
| S42.192B | ICD10CM | Covered |
| S42.221B | ICD10CM | Covered |
| S42.222B | ICD10CM | Covered |
| S42.224B | ICD10CM | Covered |
| S42.225B | ICD10CM | Covered |
| S42.231B | ICD10CM | Covered |
| S42.232B | ICD10CM | Covered |
| S42.241B | ICD10CM | Covered |
| S42.242B | ICD10CM | Covered |
| S42.251B | ICD10CM | Covered |
| S42.252B | ICD10CM | Covered |
| S42.254B | ICD10CM | Covered |
| S42.255B | ICD10CM | Covered |
| S42.261B | ICD10CM | Covered |
| S42.262B | ICD10CM | Covered |
| S42.264B | ICD10CM | Covered |
| S42.265B | ICD10CM | Covered |
| S42.291B | ICD10CM | Covered |
| S42.292B | ICD10CM | Covered |
| S42.294B | ICD10CM | Covered |
| S42.295B | ICD10CM | Covered |
| S42.321B | ICD10CM | Covered |
| S42.322B | ICD10CM | Covered |
| S42.324B | ICD10CM | Covered |
| S42.325B | ICD10CM | Covered |
| S42.331B | ICD10CM | Covered |
| S42.332B | ICD10CM | Covered |
| S42.334B | ICD10CM | Covered |
| S42.335B | ICD10CM | Covered |
| S42.341B | ICD10CM | Covered |
| S42.342B | ICD10CM | Covered |
| S42.344B | ICD10CM | Covered |
| S42.345B | ICD10CM | Covered |
| S42.351B | ICD10CM | Covered |
| S42.352B | ICD10CM | Covered |
| S42.354B | ICD10CM | Covered |
| S42.355B | ICD10CM | Covered |
| S42.361B | ICD10CM | Covered |
| S42.362B | ICD10CM | Covered |
| S42.364B | ICD10CM | Covered |
| S42.365B | ICD10CM | Covered |
| S42.391B | ICD10CM | Covered |
| S42.392B | ICD10CM | Covered |
| S42.411B | ICD10CM | Covered |
| S42.412B | ICD10CM | Covered |
| S42.414B | ICD10CM | Covered |
| S42.415B | ICD10CM | Covered |
| S42.421B | ICD10CM | Covered |
| S42.422B | ICD10CM | Covered |
| S42.424B | ICD10CM | Covered |
| S42.425B | ICD10CM | Covered |
| S42.431B | ICD10CM | Covered |
| S42.432B | ICD10CM | Covered |
| S42.434B | ICD10CM | Covered |
| S42.435B | ICD10CM | Covered |
| S42.441B | ICD10CM | Covered |
| S42.442B | ICD10CM | Covered |
| S42.444B | ICD10CM | Covered |
| S42.445B | ICD10CM | Covered |
| S42.447B | ICD10CM | Covered |
| S42.448B | ICD10CM | Covered |
| S42.451B | ICD10CM | Covered |
| S42.452B | ICD10CM | Covered |
| S42.454B | ICD10CM | Covered |
| S42.455B | ICD10CM | Covered |
| S42.461B | ICD10CM | Covered |
| S42.462B | ICD10CM | Covered |
| S42.464B | ICD10CM | Covered |
| S42.465B | ICD10CM | Covered |
| S42.471B | ICD10CM | Covered |
| S42.472B | ICD10CM | Covered |
| S42.474B | ICD10CM | Covered |
| S42.475B | ICD10CM | Covered |
| S42.491B | ICD10CM | Covered |
| S42.492B | ICD10CM | Covered |
| S42.494B | ICD10CM | Covered |
| S42.495B | ICD10CM | Covered |
| S46.021A | ICD10CM | Covered |
| S46.022A | ICD10CM | Covered |
| S46.121A | ICD10CM | Covered |
| S46.122A | ICD10CM | Covered |
| S46.221A | ICD10CM | Covered |
| S46.222A | ICD10CM | Covered |
| S46.321A | ICD10CM | Covered |
| S46.322A | ICD10CM | Covered |
| S46.821A | ICD10CM | Covered |
| S46.822A | ICD10CM | Covered |
| S48.011A | ICD10CM | Covered |
| S48.012A | ICD10CM | Covered |
| S48.021A | ICD10CM | Covered |
| S48.022A | ICD10CM | Covered |
| S48.111A | ICD10CM | Covered |
| S48.112A | ICD10CM | Covered |
| S48.121A | ICD10CM | Covered |
| S48.122A | ICD10CM | Covered |
| S48.911A | ICD10CM | Covered |
| S48.912A | ICD10CM | Covered |
| S48.921A | ICD10CM | Covered |
| S48.922A | ICD10CM | Covered |
| S50.311A | ICD10CM | Covered |
| S50.312A | ICD10CM | Covered |
| S50.321A | ICD10CM | Covered |
| S50.322A | ICD10CM | Covered |
| S50.341A | ICD10CM | Covered |
| S50.342A | ICD10CM | Covered |
| S50.351A | ICD10CM | Covered |
| S50.352A | ICD10CM | Covered |
| S50.361A | ICD10CM | Covered |
| S50.362A | ICD10CM | Covered |
| S50.371A | ICD10CM | Covered |
| S50.372A | ICD10CM | Covered |
| S50.811A | ICD10CM | Covered |
| S50.812A | ICD10CM | Covered |
| S50.821A | ICD10CM | Covered |
| S50.822A | ICD10CM | Covered |
| S50.841A | ICD10CM | Covered |
| S50.842A | ICD10CM | Covered |
| S50.851A | ICD10CM | Covered |
| S50.852A | ICD10CM | Covered |
| S50.861A | ICD10CM | Covered |
| S50.862A | ICD10CM | Covered |
| S50.871A | ICD10CM | Covered |
| S50.872A | ICD10CM | Covered |
| S50.901A | ICD10CM | Covered |
| S50.902A | ICD10CM | Covered |
| S50.911A | ICD10CM | Covered |
| S50.912A | ICD10CM | Covered |
| S51.011A | ICD10CM | Covered |
| S51.012A | ICD10CM | Covered |
| S51.021A | ICD10CM | Covered |
| S51.022A | ICD10CM | Covered |
| S51.031A | ICD10CM | Covered |
| S51.032A | ICD10CM | Covered |
| S51.041A | ICD10CM | Covered |
| S51.042A | ICD10CM | Covered |
| S51.051A | ICD10CM | Covered |
| S51.052A | ICD10CM | Covered |
| S51.811A | ICD10CM | Covered |
| S51.812A | ICD10CM | Covered |
| S51.821A | ICD10CM | Covered |