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 1,057 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 92285 | HCPCS | Covered |
| A18.51 | ICD10CM | Covered |
| A18.52 | ICD10CM | Covered |
| A18.54 | ICD10CM | Covered |
| A18.59 | ICD10CM | Covered |
| A50.31 | ICD10CM | Covered |
| B00.50 | ICD10CM | Covered |
| B00.51 | ICD10CM | Covered |
| B00.52 | ICD10CM | Covered |
| B00.53 | ICD10CM | Covered |
| B00.59 | ICD10CM | Covered |
| B02.31 | ICD10CM | Covered |
| B02.32 | ICD10CM | Covered |
| B02.33 | ICD10CM | Covered |
| B02.34 | ICD10CM | Covered |
| B02.39 | ICD10CM | Covered |
| B10.81 | ICD10CM | Covered |
| B10.82 | ICD10CM | Covered |
| B10.89 | ICD10CM | Covered |
| B30.0 | ICD10CM | Covered |
| B60.12 | ICD10CM | Covered |
| B60.13 | ICD10CM | Covered |
| C43.111 | ICD10CM | Covered |
| C43.112 | ICD10CM | Covered |
| C43.121 | ICD10CM | Covered |
| C43.122 | ICD10CM | Covered |
| C43.30 | ICD10CM | Covered |
| C43.31 | ICD10CM | Covered |
| C43.39 | ICD10CM | Covered |
| C44.1121 | ICD10CM | Covered |
| C44.1122 | ICD10CM | Covered |
| C44.1191 | ICD10CM | Covered |
| C44.1192 | ICD10CM | Covered |
| C44.1221 | ICD10CM | Covered |
| C44.1222 | ICD10CM | Covered |
| C44.1291 | ICD10CM | Covered |
| C44.1292 | ICD10CM | Covered |
| C44.1921 | ICD10CM | Covered |
| C44.1922 | ICD10CM | Covered |
| C44.1991 | ICD10CM | Covered |
| C44.1992 | ICD10CM | Covered |
| C47.0 | ICD10CM | Covered |
| C49.0 | ICD10CM | Covered |
| C69.01 | ICD10CM | Covered |
| C69.02 | ICD10CM | Covered |
| C69.11 | ICD10CM | Covered |
| C69.12 | ICD10CM | Covered |
| C69.41 | ICD10CM | Covered |
| C69.42 | ICD10CM | Covered |
| C69.51 | ICD10CM | Covered |
| C69.52 | ICD10CM | Covered |
| C69.61 | ICD10CM | Covered |
| C69.62 | ICD10CM | Covered |
| C69.81 | ICD10CM | Covered |
| C69.82 | ICD10CM | Covered |
| C69.91 | ICD10CM | Covered |
| C69.92 | ICD10CM | Covered |
| D03.111 | ICD10CM | Covered |
| D03.112 | ICD10CM | Covered |
| D03.121 | ICD10CM | Covered |
| D03.122 | ICD10CM | Covered |
| D03.30 | ICD10CM | Covered |
| D03.39 | ICD10CM | Covered |
| D04.111 | ICD10CM | Covered |
| D04.112 | ICD10CM | Covered |
| D04.121 | ICD10CM | Covered |
| D04.122 | ICD10CM | Covered |
| D09.21 | ICD10CM | Covered |
| D09.22 | ICD10CM | Covered |
| D22.111 | ICD10CM | Covered |
| D22.112 | ICD10CM | Covered |
| D22.121 | ICD10CM | Covered |
| D22.122 | ICD10CM | Covered |
| D22.30 | ICD10CM | Covered |
| D22.39 | ICD10CM | Covered |
| D23.111 | ICD10CM | Covered |
| D23.112 | ICD10CM | Covered |
| D23.121 | ICD10CM | Covered |
| D23.122 | ICD10CM | Covered |
| D23.30 | ICD10CM | Covered |
| D23.39 | ICD10CM | Covered |
| D31.01 | ICD10CM | Covered |
| D31.02 | ICD10CM | Covered |
| D31.11 | ICD10CM | Covered |
| D31.12 | ICD10CM | Covered |
| D31.41 | ICD10CM | Covered |
| D31.42 | ICD10CM | Covered |
| D31.51 | ICD10CM | Covered |
| D31.52 | ICD10CM | Covered |
| D31.61 | ICD10CM | Covered |
| D31.62 | ICD10CM | Covered |
| D31.91 | ICD10CM | Covered |
| D31.92 | ICD10CM | Covered |
| D48.7 | ICD10CM | Covered |
| H00.011 | ICD10CM | Covered |
| H00.012 | ICD10CM | Covered |
| H00.014 | ICD10CM | Covered |
| H00.015 | ICD10CM | Covered |
| H00.021 | ICD10CM | Covered |
| H00.022 | ICD10CM | Covered |
| H00.024 | ICD10CM | Covered |
| H00.025 | ICD10CM | Covered |
| H00.031 | ICD10CM | Covered |
| H00.032 | ICD10CM | Covered |
| H00.034 | ICD10CM | Covered |
| H00.035 | ICD10CM | Covered |
| H00.11 | ICD10CM | Covered |
| H00.12 | ICD10CM | Covered |
| H00.14 | ICD10CM | Covered |
| H00.15 | ICD10CM | Covered |
| H01.001 | ICD10CM | Covered |
| H01.002 | ICD10CM | Covered |
| H01.004 | ICD10CM | Covered |
| H01.005 | ICD10CM | Covered |
| H01.00A | ICD10CM | Covered |
| H01.00B | ICD10CM | Covered |
| H01.011 | ICD10CM | Covered |
| H01.012 | ICD10CM | Covered |
| H01.014 | ICD10CM | Covered |
| H01.015 | ICD10CM | Covered |
| H01.01A | ICD10CM | Covered |
| H01.01B | ICD10CM | Covered |
| H01.021 | ICD10CM | Covered |
| H01.022 | ICD10CM | Covered |
| H01.024 | ICD10CM | Covered |
| H01.025 | ICD10CM | Covered |
| H01.02A | ICD10CM | Covered |
| H01.02B | ICD10CM | Covered |
| H01.111 | ICD10CM | Covered |
| H01.112 | ICD10CM | Covered |
| H01.114 | ICD10CM | Covered |
| H01.115 | ICD10CM | Covered |
| H01.121 | ICD10CM | Covered |
| H01.122 | ICD10CM | Covered |
| H01.124 | ICD10CM | Covered |
| H01.125 | ICD10CM | Covered |
| H01.131 | ICD10CM | Covered |
| H01.132 | ICD10CM | Covered |
| H01.134 | ICD10CM | Covered |
| H01.135 | ICD10CM | Covered |
| H01.141 | ICD10CM | Covered |
| H01.142 | ICD10CM | Covered |
| H01.144 | ICD10CM | Covered |
| H01.145 | ICD10CM | Covered |
| H01.81 | ICD10CM | Covered |
| H01.82 | ICD10CM | Covered |
| H01.84 | ICD10CM | Covered |
| H01.85 | ICD10CM | Covered |
| H01.8A | ICD10CM | Covered |
| H01.8B | ICD10CM | Covered |
| H01.9 | ICD10CM | Covered |
| H02.001 | ICD10CM | Covered |
| H02.002 | ICD10CM | Covered |
| H02.004 | ICD10CM | Covered |
| H02.005 | ICD10CM | Covered |
| H02.011 | ICD10CM | Covered |
| H02.012 | ICD10CM | Covered |
| H02.014 | ICD10CM | Covered |
| H02.015 | ICD10CM | Covered |
| H02.021 | ICD10CM | Covered |
| H02.022 | ICD10CM | Covered |
| H02.024 | ICD10CM | Covered |
| H02.025 | ICD10CM | Covered |
| H02.031 | ICD10CM | Covered |
| H02.032 | ICD10CM | Covered |
| H02.034 | ICD10CM | Covered |
| H02.035 | ICD10CM | Covered |
| H02.041 | ICD10CM | Covered |
| H02.042 | ICD10CM | Covered |
| H02.044 | ICD10CM | Covered |
| H02.045 | ICD10CM | Covered |
| H02.051 | ICD10CM | Covered |
| H02.052 | ICD10CM | Covered |
| H02.054 | ICD10CM | Covered |
| H02.055 | ICD10CM | Covered |
| H02.101 | ICD10CM | Covered |
| H02.102 | ICD10CM | Covered |
| H02.104 | ICD10CM | Covered |
| H02.105 | ICD10CM | Covered |
| H02.111 | ICD10CM | Covered |
| H02.112 | ICD10CM | Covered |
| H02.114 | ICD10CM | Covered |
| H02.115 | ICD10CM | Covered |
| H02.121 | ICD10CM | Covered |
| H02.122 | ICD10CM | Covered |
| H02.124 | ICD10CM | Covered |
| H02.125 | ICD10CM | Covered |
| H02.131 | ICD10CM | Covered |
| H02.132 | ICD10CM | Covered |
| H02.134 | ICD10CM | Covered |
| H02.135 | ICD10CM | Covered |
| H02.141 | ICD10CM | Covered |
| H02.142 | ICD10CM | Covered |
| H02.144 | ICD10CM | Covered |
| H02.145 | ICD10CM | Covered |
| H02.151 | ICD10CM | Covered |
| H02.152 | ICD10CM | Covered |
| H02.153 | ICD10CM | Covered |
| H02.154 | ICD10CM | Covered |
| H02.155 | ICD10CM | Covered |
| H02.156 | ICD10CM | Covered |
| H02.521 | ICD10CM | Covered |
| H02.522 | ICD10CM | Covered |
| H02.524 | ICD10CM | Covered |
| H02.525 | ICD10CM | Covered |
| H02.61 | ICD10CM | Covered |
| H02.62 | ICD10CM | Covered |
| H02.64 | ICD10CM | Covered |
| H02.65 | ICD10CM | Covered |
| H02.70 | ICD10CM | Covered |
| H02.711 | ICD10CM | Covered |
| H02.712 | ICD10CM | Covered |
| H02.714 | ICD10CM | Covered |
| H02.715 | ICD10CM | Covered |
| H02.721 | ICD10CM | Covered |
| H02.722 | ICD10CM | Covered |
| H02.724 | ICD10CM | Covered |
| H02.725 | ICD10CM | Covered |
| H02.731 | ICD10CM | Covered |
| H02.732 | ICD10CM | Covered |
| H02.734 | ICD10CM | Covered |
| H02.735 | ICD10CM | Covered |
| H02.79 | ICD10CM | Covered |
| H02.811 | ICD10CM | Covered |
| H02.812 | ICD10CM | Covered |
| H02.814 | ICD10CM | Covered |
| H02.815 | ICD10CM | Covered |
| H02.821 | ICD10CM | Covered |
| H02.822 | ICD10CM | Covered |
| H02.824 | ICD10CM | Covered |
| H02.825 | ICD10CM | Covered |
| H02.841 | ICD10CM | Covered |
| H02.842 | ICD10CM | Covered |
| H02.844 | ICD10CM | Covered |
| H02.845 | ICD10CM | Covered |
| H02.851 | ICD10CM | Covered |
| H02.852 | ICD10CM | Covered |
| H02.854 | ICD10CM | Covered |
| H02.855 | ICD10CM | Covered |
| H02.861 | ICD10CM | Covered |
| H02.862 | ICD10CM | Covered |
| H02.864 | ICD10CM | Covered |
| H02.865 | ICD10CM | Covered |
| H02.871 | ICD10CM | Covered |
| H02.872 | ICD10CM | Covered |
| H02.874 | ICD10CM | Covered |
| H02.875 | ICD10CM | Covered |
| H02.881 | ICD10CM | Covered |
| H02.882 | ICD10CM | Covered |
| H02.884 | ICD10CM | Covered |
| H02.885 | ICD10CM | Covered |
| H02.88A | ICD10CM | Covered |
| H02.88B | ICD10CM | Covered |
| H02.89 | ICD10CM | Covered |
| H02.9 | ICD10CM | Covered |
| H04.001 | ICD10CM | Covered |
| H04.002 | ICD10CM | Covered |
| H04.003 | ICD10CM | Covered |
| H04.011 | ICD10CM | Covered |
| H04.012 | ICD10CM | Covered |
| H04.013 | ICD10CM | Covered |
| H04.021 | ICD10CM | Covered |
| H04.022 | ICD10CM | Covered |
| H04.023 | ICD10CM | Covered |
| H04.031 | ICD10CM | Covered |
| H04.032 | ICD10CM | Covered |
| H04.033 | ICD10CM | Covered |
| H04.111 | ICD10CM | Covered |
| H04.112 | ICD10CM | Covered |
| H04.113 | ICD10CM | Covered |
| H04.121 | ICD10CM | Covered |
| H04.122 | ICD10CM | Covered |
| H04.123 | ICD10CM | Covered |
| H04.131 | ICD10CM | Covered |
| H04.132 | ICD10CM | Covered |
| H04.133 | ICD10CM | Covered |
| H04.141 | ICD10CM | Covered |
| H04.142 | ICD10CM | Covered |
| H04.143 | ICD10CM | Covered |
| H04.151 | ICD10CM | Covered |
| H04.152 | ICD10CM | Covered |
| H04.153 | ICD10CM | Covered |
| H04.161 | ICD10CM | Covered |
| H04.162 | ICD10CM | Covered |
| H04.163 | ICD10CM | Covered |
| H04.19 | ICD10CM | Covered |
| H04.301 | ICD10CM | Covered |
| H04.302 | ICD10CM | Covered |
| H04.303 | ICD10CM | Covered |
| H04.311 | ICD10CM | Covered |
| H04.312 | ICD10CM | Covered |
| H04.313 | ICD10CM | Covered |
| H04.321 | ICD10CM | Covered |
| H04.322 | ICD10CM | Covered |
| H04.323 | ICD10CM | Covered |
| H04.331 | ICD10CM | Covered |
| H04.332 | ICD10CM | Covered |
| H04.333 | ICD10CM | Covered |
| H04.411 | ICD10CM | Covered |
| H04.412 | ICD10CM | Covered |
| H04.413 | ICD10CM | Covered |
| H04.421 | ICD10CM | Covered |
| H04.422 | ICD10CM | Covered |
| H04.423 | ICD10CM | Covered |
| H04.431 | ICD10CM | Covered |
| H04.432 | ICD10CM | Covered |
| H04.433 | ICD10CM | Covered |
| H04.511 | ICD10CM | Covered |
| H04.512 | ICD10CM | Covered |
| H04.513 | ICD10CM | Covered |
| H04.521 | ICD10CM | Covered |
| H04.522 | ICD10CM | Covered |
| H04.523 | ICD10CM | Covered |
| H04.531 | ICD10CM | Covered |
| H04.532 | ICD10CM | Covered |
| H04.533 | ICD10CM | Covered |
| H04.541 | ICD10CM | Covered |
| H04.542 | ICD10CM | Covered |
| H04.543 | ICD10CM | Covered |
| H04.551 | ICD10CM | Covered |
| H04.552 | ICD10CM | Covered |
| H04.553 | ICD10CM | Covered |
| H04.561 | ICD10CM | Covered |
| H04.562 | ICD10CM | Covered |
| H04.563 | ICD10CM | Covered |
| H04.571 | ICD10CM | Covered |
| H04.572 | ICD10CM | Covered |
| H04.573 | ICD10CM | Covered |
| H04.611 | ICD10CM | Covered |
| H04.612 | ICD10CM | Covered |
| H04.613 | ICD10CM | Covered |
| H04.69 | ICD10CM | Covered |
| H04.811 | ICD10CM | Covered |
| H04.812 | ICD10CM | Covered |
| H04.813 | ICD10CM | Covered |
| H04.89 | ICD10CM | Covered |
| H04.9 | ICD10CM | Covered |
| H05.00 | ICD10CM | Covered |
| H05.011 | ICD10CM | Covered |
| H05.012 | ICD10CM | Covered |
| H05.013 | ICD10CM | Covered |
| H05.021 | ICD10CM | Covered |
| H05.022 | ICD10CM | Covered |
| H05.023 | ICD10CM | Covered |
| H05.031 | ICD10CM | Covered |
| H05.032 | ICD10CM | Covered |
| H05.033 | ICD10CM | Covered |
| H05.041 | ICD10CM | Covered |
| H05.042 | ICD10CM | Covered |
| H05.043 | ICD10CM | Covered |
| H05.10 | ICD10CM | Covered |
| H05.111 | ICD10CM | Covered |
| H05.112 | ICD10CM | Covered |
| H05.113 | ICD10CM | Covered |
| H05.121 | ICD10CM | Covered |
| H05.122 | ICD10CM | Covered |
| H05.123 | ICD10CM | Covered |
| H05.20 | ICD10CM | Covered |
| H05.211 | ICD10CM | Covered |
| H05.212 | ICD10CM | Covered |
| H05.213 | ICD10CM | Covered |
| H05.221 | ICD10CM | Covered |
| H05.222 | ICD10CM | Covered |
| H05.223 | ICD10CM | Covered |
| H05.231 | ICD10CM | Covered |
| H05.232 | ICD10CM | Covered |
| H05.233 | ICD10CM | Covered |
| H05.241 | ICD10CM | Covered |
| H05.242 | ICD10CM | Covered |
| H05.243 | ICD10CM | Covered |
| H05.251 | ICD10CM | Covered |
| H05.252 | ICD10CM | Covered |
| H05.253 | ICD10CM | Covered |
| H05.261 | ICD10CM | Covered |
| H05.262 | ICD10CM | Covered |
| H05.263 | ICD10CM | Covered |
| H05.30 | ICD10CM | Covered |
| H05.311 | ICD10CM | Covered |
| H05.312 | ICD10CM | Covered |
| H05.313 | ICD10CM | Covered |
| H05.321 | ICD10CM | Covered |
| H05.322 | ICD10CM | Covered |
| H05.323 | ICD10CM | Covered |
| H05.331 | ICD10CM | Covered |
| H05.332 | ICD10CM | Covered |
| H05.333 | ICD10CM | Covered |
| H05.341 | ICD10CM | Covered |
| H05.342 | ICD10CM | Covered |
| H05.343 | ICD10CM | Covered |
| H05.351 | ICD10CM | Covered |
| H05.352 | ICD10CM | Covered |
| H05.353 | ICD10CM | Covered |
| H05.401 | ICD10CM | Covered |
| H05.402 | ICD10CM | Covered |
| H05.403 | ICD10CM | Covered |
| H05.411 | ICD10CM | Covered |
| H05.412 | ICD10CM | Covered |
| H05.413 | ICD10CM | Covered |
| H05.421 | ICD10CM | Covered |
| H05.422 | ICD10CM | Covered |
| H05.423 | ICD10CM | Covered |
| H05.51 | ICD10CM | Covered |
| H05.52 | ICD10CM | Covered |
| H05.53 | ICD10CM | Covered |
| H05.811 | ICD10CM | Covered |
| H05.812 | ICD10CM | Covered |
| H05.813 | ICD10CM | Covered |
| H05.821 | ICD10CM | Covered |
| H05.822 | ICD10CM | Covered |
| H05.823 | ICD10CM | Covered |
| H05.831 | ICD10CM | Covered |
| H05.832 | ICD10CM | Covered |
| H05.833 | ICD10CM | Covered |
| H05.89 | ICD10CM | Covered |
| H05.9 | ICD10CM | Covered |
| H10.011 | ICD10CM | Covered |
| H10.012 | ICD10CM | Covered |
| H10.013 | ICD10CM | Covered |
| H10.021 | ICD10CM | Covered |
| H10.022 | ICD10CM | Covered |
| H10.023 | ICD10CM | Covered |
| H10.11 | ICD10CM | Covered |
| H10.12 | ICD10CM | Covered |
| H10.13 | ICD10CM | Covered |
| H10.211 | ICD10CM | Covered |
| H10.212 | ICD10CM | Covered |
| H10.213 | ICD10CM | Covered |
| H10.221 | ICD10CM | Covered |
| H10.222 | ICD10CM | Covered |
| H10.223 | ICD10CM | Covered |
| H10.231 | ICD10CM | Covered |
| H10.232 | ICD10CM | Covered |
| H10.233 | ICD10CM | Covered |
| H10.31 | ICD10CM | Covered |
| H10.32 | ICD10CM | Covered |
| H10.33 | ICD10CM | Covered |
| H10.401 | ICD10CM | Covered |
| H10.402 | ICD10CM | Covered |
| H10.403 | ICD10CM | Covered |
| H10.411 | ICD10CM | Covered |
| H10.412 | ICD10CM | Covered |
| H10.413 | ICD10CM | Covered |
| H10.421 | ICD10CM | Covered |
| H10.422 | ICD10CM | Covered |
| H10.423 | ICD10CM | Covered |
| H10.431 | ICD10CM | Covered |
| H10.432 | ICD10CM | Covered |
| H10.433 | ICD10CM | Covered |
| H10.44 | ICD10CM | Covered |
| H10.45 | ICD10CM | Covered |
| H10.501 | ICD10CM | Covered |
| H10.502 | ICD10CM | Covered |
| H10.503 | ICD10CM | Covered |
| H10.511 | ICD10CM | Covered |
| H10.512 | ICD10CM | Covered |
| H10.513 | ICD10CM | Covered |
| H10.521 | ICD10CM | Covered |
| H10.522 | ICD10CM | Covered |
| H10.523 | ICD10CM | Covered |
| H10.531 | ICD10CM | Covered |
| H10.532 | ICD10CM | Covered |
| H10.533 | ICD10CM | Covered |
| H10.821 | ICD10CM | Covered |
| H10.822 | ICD10CM | Covered |
| H10.823 | ICD10CM | Covered |
| H10.89 | ICD10CM | Covered |
| H10.9 | ICD10CM | Covered |
| H11.001 | ICD10CM | Covered |
| H11.002 | ICD10CM | Covered |
| H11.003 | ICD10CM | Covered |
| H11.011 | ICD10CM | Covered |
| H11.012 | ICD10CM | Covered |
| H11.013 | ICD10CM | Covered |
| H11.021 | ICD10CM | Covered |
| H11.022 | ICD10CM | Covered |
| H11.023 | ICD10CM | Covered |
| H11.031 | ICD10CM | Covered |
| H11.032 | ICD10CM | Covered |
| H11.033 | ICD10CM | Covered |
| H11.041 | ICD10CM | Covered |
| H11.042 | ICD10CM | Covered |
| H11.043 | ICD10CM | Covered |
| H11.051 | ICD10CM | Covered |
| H11.052 | ICD10CM | Covered |
| H11.053 | ICD10CM | Covered |
| H11.061 | ICD10CM | Covered |
| H11.062 | ICD10CM | Covered |
| H11.063 | ICD10CM | Covered |
| H11.10 | ICD10CM | Covered |
| H11.111 | ICD10CM | Covered |
| H11.112 | ICD10CM | Covered |
| H11.113 | ICD10CM | Covered |
| H11.121 | ICD10CM | Covered |
| H11.122 | ICD10CM | Covered |
| H11.123 | ICD10CM | Covered |
| H11.131 | ICD10CM | Covered |
| H11.132 | ICD10CM | Covered |
| H11.133 | ICD10CM | Covered |
| H11.141 | ICD10CM | Covered |
| H11.142 | ICD10CM | Covered |
| H11.143 | ICD10CM | Covered |
| H11.151 | ICD10CM | Covered |
| H11.152 | ICD10CM | Covered |
| H11.153 | ICD10CM | Covered |
| H11.211 | ICD10CM | Covered |
| H11.212 | ICD10CM | Covered |
| H11.213 | ICD10CM | Covered |
| H11.221 | ICD10CM | Covered |
| H11.222 | ICD10CM | Covered |
| H11.223 | ICD10CM | Covered |
| H11.231 | ICD10CM | Covered |
| H11.232 | ICD10CM | Covered |
| H11.233 | ICD10CM | Covered |
| H11.241 | ICD10CM | Covered |
| H11.242 | ICD10CM | Covered |
| H11.243 | ICD10CM | Covered |
| H11.31 | ICD10CM | Covered |
| H11.32 | ICD10CM | Covered |
| H11.33 | ICD10CM | Covered |
| H11.411 | ICD10CM | Covered |
| H11.412 | ICD10CM | Covered |
| H11.413 | ICD10CM | Covered |
| H11.421 | ICD10CM | Covered |
| H11.422 | ICD10CM | Covered |
| H11.423 | ICD10CM | Covered |
| H11.431 | ICD10CM | Covered |
| H11.432 | ICD10CM | Covered |
| H11.433 | ICD10CM | Covered |
| H11.441 | ICD10CM | Covered |
| H11.442 | ICD10CM | Covered |
| H11.443 | ICD10CM | Covered |
| H11.811 | ICD10CM | Covered |
| H11.812 | ICD10CM | Covered |
| H11.813 | ICD10CM | Covered |
| H11.821 | ICD10CM | Covered |
| H11.822 | ICD10CM | Covered |
| H11.823 | ICD10CM | Covered |
| H11.89 | ICD10CM | Covered |
| H11.9 | ICD10CM | Covered |
| H15.001 | ICD10CM | Covered |
| H15.002 | ICD10CM | Covered |
| H15.003 | ICD10CM | Covered |
| H15.011 | ICD10CM | Covered |
| H15.012 | ICD10CM | Covered |
| H15.013 | ICD10CM | Covered |
| H15.021 | ICD10CM | Covered |
| H15.022 | ICD10CM | Covered |
| H15.023 | ICD10CM | Covered |
| H15.031 | ICD10CM | Covered |
| H15.032 | ICD10CM | Covered |
| H15.033 | ICD10CM | Covered |
| H15.041 | ICD10CM | Covered |
| H15.042 | ICD10CM | Covered |
| H15.043 | ICD10CM | Covered |
| H15.051 | ICD10CM | Covered |
| H15.052 | ICD10CM | Covered |
| H15.053 | ICD10CM | Covered |
| H15.091 | ICD10CM | Covered |
| H15.092 | ICD10CM | Covered |
| H15.093 | ICD10CM | Covered |
| H15.101 | ICD10CM | Covered |
| H15.102 | ICD10CM | Covered |
| H15.103 | ICD10CM | Covered |
| H15.111 | ICD10CM | Covered |
| H15.112 | ICD10CM | Covered |
| H15.113 | ICD10CM | Covered |
| H15.121 | ICD10CM | Covered |
| H15.122 | ICD10CM | Covered |
| H15.123 | ICD10CM | Covered |
| H15.811 | ICD10CM | Covered |
| H15.812 | ICD10CM | Covered |
| H15.813 | ICD10CM | Covered |
| H15.821 | ICD10CM | Covered |
| H15.822 | ICD10CM | Covered |
| H15.823 | ICD10CM | Covered |
| H15.841 | ICD10CM | Covered |
| H15.842 | ICD10CM | Covered |
| H15.843 | ICD10CM | Covered |
| H15.851 | ICD10CM | Covered |
| H15.852 | ICD10CM | Covered |
| H15.853 | ICD10CM | Covered |
| H16.001 | ICD10CM | Covered |
| H16.002 | ICD10CM | Covered |
| H16.003 | ICD10CM | Covered |
| H16.011 | ICD10CM | Covered |
| H16.012 | ICD10CM | Covered |
| H16.013 | ICD10CM | Covered |
| H16.021 | ICD10CM | Covered |
| H16.022 | ICD10CM | Covered |
| H16.023 | ICD10CM | Covered |
| H16.031 | ICD10CM | Covered |
| H16.032 | ICD10CM | Covered |
| H16.033 | ICD10CM | Covered |
| H16.041 | ICD10CM | Covered |
| H16.042 | ICD10CM | Covered |
| H16.043 | ICD10CM | Covered |
| H16.051 | ICD10CM | Covered |
| H16.052 | ICD10CM | Covered |
| H16.053 | ICD10CM | Covered |
| H16.061 | ICD10CM | Covered |
| H16.062 | ICD10CM | Covered |
| H16.063 | ICD10CM | Covered |
| H16.071 | ICD10CM | Covered |
| H16.072 | ICD10CM | Covered |
| H16.073 | ICD10CM | Covered |
| H16.101 | ICD10CM | Covered |
| H16.102 | ICD10CM | Covered |
| H16.103 | ICD10CM | Covered |
| H16.111 | ICD10CM | Covered |
| H16.112 | ICD10CM | Covered |
| H16.113 | ICD10CM | Covered |
| H16.121 | ICD10CM | Covered |
| H16.122 | ICD10CM | Covered |
| H16.123 | ICD10CM | Covered |
| H16.131 | ICD10CM | Covered |
| H16.132 | ICD10CM | Covered |
| H16.133 | ICD10CM | Covered |
| H16.141 | ICD10CM | Covered |
| H16.142 | ICD10CM | Covered |
| H16.143 | ICD10CM | Covered |
| H16.211 | ICD10CM | Covered |
| H16.212 | ICD10CM | Covered |
| H16.213 | ICD10CM | Covered |
| H16.221 | ICD10CM | Covered |
| H16.222 | ICD10CM | Covered |
| H16.223 | ICD10CM | Covered |
| H16.231 | ICD10CM | Covered |
| H16.232 | ICD10CM | Covered |
| H16.233 | ICD10CM | Covered |
| H16.241 | ICD10CM | Covered |
| H16.242 | ICD10CM | Covered |
| H16.243 | ICD10CM | Covered |
| H16.251 | ICD10CM | Covered |
| H16.252 | ICD10CM | Covered |
| H16.253 | ICD10CM | Covered |
| H16.261 | ICD10CM | Covered |
| H16.262 | ICD10CM | Covered |
| H16.263 | ICD10CM | Covered |
| H16.301 | ICD10CM | Covered |
| H16.302 | ICD10CM | Covered |
| H16.303 | ICD10CM | Covered |
| H16.311 | ICD10CM | Covered |
| H16.312 | ICD10CM | Covered |
| H16.313 | ICD10CM | Covered |
| H16.321 | ICD10CM | Covered |
| H16.322 | ICD10CM | Covered |
| H16.323 | ICD10CM | Covered |
| H16.331 | ICD10CM | Covered |
| H16.332 | ICD10CM | Covered |
| H16.333 | ICD10CM | Covered |
| H16.401 | ICD10CM | Covered |
| H16.402 | ICD10CM | Covered |
| H16.403 | ICD10CM | Covered |
| H16.411 | ICD10CM | Covered |
| H16.412 | ICD10CM | Covered |
| H16.413 | ICD10CM | Covered |
| H16.421 | ICD10CM | Covered |
| H16.422 | ICD10CM | Covered |
| H16.423 | ICD10CM | Covered |
| H16.431 | ICD10CM | Covered |
| H16.432 | ICD10CM | Covered |
| H16.433 | ICD10CM | Covered |
| H16.441 | ICD10CM | Covered |
| H16.442 | ICD10CM | Covered |
| H16.443 | ICD10CM | Covered |
| H16.8 | ICD10CM | Covered |
| H16.9 | ICD10CM | Covered |
| H17.01 | ICD10CM | Covered |
| H17.02 | ICD10CM | Covered |
| H17.03 | ICD10CM | Covered |
| H17.11 | ICD10CM | Covered |
| H17.12 | ICD10CM | Covered |
| H17.13 | ICD10CM | Covered |
| H17.811 | ICD10CM | Covered |
| H17.812 | ICD10CM | Covered |
| H17.813 | ICD10CM | Covered |
| H17.821 | ICD10CM | Covered |
| H17.822 | ICD10CM | Covered |
| H17.823 | ICD10CM | Covered |
| H17.89 | ICD10CM | Covered |
| H17.9 | ICD10CM | Covered |
| H18.001 | ICD10CM | Covered |
| H18.002 | ICD10CM | Covered |
| H18.003 | ICD10CM | Covered |
| H18.011 | ICD10CM | Covered |
| H18.012 | ICD10CM | Covered |
| H18.013 | ICD10CM | Covered |
| H18.021 | ICD10CM | Covered |
| H18.022 | ICD10CM | Covered |
| H18.023 | ICD10CM | Covered |
| H18.031 | ICD10CM | Covered |
| H18.032 | ICD10CM | Covered |
| H18.033 | ICD10CM | Covered |
| H18.041 | ICD10CM | Covered |
| H18.042 | ICD10CM | Covered |
| H18.043 | ICD10CM | Covered |
| H18.051 | ICD10CM | Covered |
| H18.052 | ICD10CM | Covered |
| H18.053 | ICD10CM | Covered |
| H18.061 | ICD10CM | Covered |
| H18.062 | ICD10CM | Covered |
| H18.063 | ICD10CM | Covered |
| H18.11 | ICD10CM | Covered |
| H18.12 | ICD10CM | Covered |
| H18.13 | ICD10CM | Covered |
| H18.20 | ICD10CM | Covered |
| H18.211 | ICD10CM | Covered |
| H18.212 | ICD10CM | Covered |
| H18.213 | ICD10CM | Covered |
| H18.221 | ICD10CM | Covered |
| H18.222 | ICD10CM | Covered |
| H18.223 | ICD10CM | Covered |
| H18.231 | ICD10CM | Covered |
| H18.232 | ICD10CM | Covered |
| H18.233 | ICD10CM | Covered |
| H18.30 | ICD10CM | Covered |
| H18.311 | ICD10CM | Covered |
| H18.312 | ICD10CM | Covered |
| H18.313 | ICD10CM | Covered |
| H18.321 | ICD10CM | Covered |
| H18.322 | ICD10CM | Covered |
| H18.323 | ICD10CM | Covered |
| H18.331 | ICD10CM | Covered |
| H18.332 | ICD10CM | Covered |
| H18.333 | ICD10CM | Covered |
| H18.40 | ICD10CM | Covered |
| H18.411 | ICD10CM | Covered |
| H18.412 | ICD10CM | Covered |
| H18.413 | ICD10CM | Covered |
| H18.421 | ICD10CM | Covered |
| H18.422 | ICD10CM | Covered |
| H18.423 | ICD10CM | Covered |
| H18.43 | ICD10CM | Covered |
| H18.441 | ICD10CM | Covered |
| H18.442 | ICD10CM | Covered |
| H18.443 | ICD10CM | Covered |
| H18.451 | ICD10CM | Covered |
| H18.452 | ICD10CM | Covered |
| H18.453 | ICD10CM | Covered |
| H18.461 | ICD10CM | Covered |
| H18.462 | ICD10CM | Covered |
| H18.463 | ICD10CM | Covered |
| H18.49 | ICD10CM | Covered |
| H18.501 | ICD10CM | Covered |
| H18.502 | ICD10CM | Covered |
| H18.503 | ICD10CM | Covered |
| H18.511 | ICD10CM | Covered |
| H18.512 | ICD10CM | Covered |
| H18.513 | ICD10CM | Covered |
| H18.521 | ICD10CM | Covered |
| H18.522 | ICD10CM | Covered |
| H18.523 | ICD10CM | Covered |
| H18.531 | ICD10CM | Covered |
| H18.532 | ICD10CM | Covered |
| H18.533 | ICD10CM | Covered |
| H18.541 | ICD10CM | Covered |
| H18.542 | ICD10CM | Covered |
| H18.543 | ICD10CM | Covered |
| H18.551 | ICD10CM | Covered |
| H18.552 | ICD10CM | Covered |
| H18.553 | ICD10CM | Covered |
| H18.591 | ICD10CM | Covered |
| H18.592 | ICD10CM | Covered |
| H18.593 | ICD10CM | Covered |
| H18.601 | ICD10CM | Covered |
| H18.602 | ICD10CM | Covered |
| H18.603 | ICD10CM | Covered |
| H18.611 | ICD10CM | Covered |
| H18.612 | ICD10CM | Covered |
| H18.613 | ICD10CM | Covered |
| H18.621 | ICD10CM | Covered |
| H18.622 | ICD10CM | Covered |
| H18.623 | ICD10CM | Covered |
| H18.70 | ICD10CM | Covered |
| H18.711 | ICD10CM | Covered |
| H18.712 | ICD10CM | Covered |
| H18.713 | ICD10CM | Covered |
| H18.721 | ICD10CM | Covered |
| H18.722 | ICD10CM | Covered |
| H18.723 | ICD10CM | Covered |
| H18.731 | ICD10CM | Covered |
| H18.732 | ICD10CM | Covered |
| H18.733 | ICD10CM | Covered |
| H18.791 | ICD10CM | Covered |
| H18.792 | ICD10CM | Covered |
| H18.793 | ICD10CM | Covered |
| H18.831 | ICD10CM | Covered |
| H18.832 | ICD10CM | Covered |
| H18.833 | ICD10CM | Covered |
| H18.9 | ICD10CM | Covered |
| H20.00 | ICD10CM | Covered |
| H20.011 | ICD10CM | Covered |
| H20.012 | ICD10CM | Covered |
| H20.013 | ICD10CM | Covered |
| H20.021 | ICD10CM | Covered |
| H20.022 | ICD10CM | Covered |
| H20.023 | ICD10CM | Covered |
| H20.031 | ICD10CM | Covered |
| H20.032 | ICD10CM | Covered |
| H20.033 | ICD10CM | Covered |
| H20.041 | ICD10CM | Covered |
| H20.042 | ICD10CM | Covered |
| H20.043 | ICD10CM | Covered |
| H20.051 | ICD10CM | Covered |
| H20.052 | ICD10CM | Covered |
| H20.053 | ICD10CM | Covered |
| H20.11 | ICD10CM | Covered |
| H20.12 | ICD10CM | Covered |
| H20.13 | ICD10CM | Covered |
| H20.21 | ICD10CM | Covered |
| H20.22 | ICD10CM | Covered |
| H20.23 | ICD10CM | Covered |
| H20.811 | ICD10CM | Covered |
| H20.812 | ICD10CM | Covered |
| H20.813 | ICD10CM | Covered |
| H20.821 | ICD10CM | Covered |
| H20.822 | ICD10CM | Covered |
| H20.823 | ICD10CM | Covered |
| H20.9 | ICD10CM | Covered |
| H21.01 | ICD10CM | Covered |
| H21.02 | ICD10CM | Covered |
| H21.03 | ICD10CM | Covered |
| H21.1X1 | ICD10CM | Covered |
| H21.1X2 | ICD10CM | Covered |
| H21.1X3 | ICD10CM | Covered |
| H21.211 | ICD10CM | Covered |
| H21.212 | ICD10CM | Covered |
| H21.213 | ICD10CM | Covered |
| H21.221 | ICD10CM | Covered |
| H21.222 | ICD10CM | Covered |
| H21.223 | ICD10CM | Covered |
| H21.231 | ICD10CM | Covered |
| H21.232 | ICD10CM | Covered |
| H21.233 | ICD10CM | Covered |
| H21.241 | ICD10CM | Covered |
| H21.242 | ICD10CM | Covered |
| H21.243 | ICD10CM | Covered |
| H21.251 | ICD10CM | Covered |
| H21.252 | ICD10CM | Covered |
| H21.253 | ICD10CM | Covered |
| H21.261 | ICD10CM | Covered |
| H21.262 | ICD10CM | Covered |
| H21.263 | ICD10CM | Covered |
| H21.271 | ICD10CM | Covered |
| H21.272 | ICD10CM | Covered |
| H21.273 | ICD10CM | Covered |
| H21.29 | ICD10CM | Covered |
| H21.301 | ICD10CM | Covered |
| H21.302 | ICD10CM | Covered |
| H21.303 | ICD10CM | Covered |
| H21.311 | ICD10CM | Covered |
| H21.312 | ICD10CM | Covered |
| H21.313 | ICD10CM | Covered |
| H21.321 | ICD10CM | Covered |
| H21.322 | ICD10CM | Covered |
| H21.323 | ICD10CM | Covered |
| H21.331 | ICD10CM | Covered |
| H21.332 | ICD10CM | Covered |
| H21.333 | ICD10CM | Covered |
| H21.341 | ICD10CM | Covered |
| H21.342 | ICD10CM | Covered |
| H21.343 | ICD10CM | Covered |
| H21.351 | ICD10CM | Covered |
| H21.352 | ICD10CM | Covered |
| H21.353 | ICD10CM | Covered |
| H21.41 | ICD10CM | Covered |
| H21.42 | ICD10CM | Covered |
| H21.43 | ICD10CM | Covered |
| H21.501 | ICD10CM | Covered |
| H21.502 | ICD10CM | Covered |
| H21.503 | ICD10CM | Covered |
| H21.511 | ICD10CM | Covered |
| H21.512 | ICD10CM | Covered |
| H21.513 | ICD10CM | Covered |
| H21.521 | ICD10CM | Covered |
| H21.522 | ICD10CM | Covered |
| H21.523 | ICD10CM | Covered |
| H21.531 | ICD10CM | Covered |
| H21.532 | ICD10CM | Covered |
| H21.533 | ICD10CM | Covered |
| H21.541 | ICD10CM | Covered |
| H21.542 | ICD10CM | Covered |
| H21.543 | ICD10CM | Covered |
| H21.551 | ICD10CM | Covered |
| H21.552 | ICD10CM | Covered |
| H21.553 | ICD10CM | Covered |
| H21.561 | ICD10CM | Covered |
| H21.562 | ICD10CM | Covered |
| H21.563 | ICD10CM | Covered |
| H21.81 | ICD10CM | Covered |
| H21.89 | ICD10CM | Covered |
| H21.9 | ICD10CM | Covered |
| H22 | ICD10CM | Covered |
| H25.89 | ICD10CM | Covered |
| H27.01 | ICD10CM | Covered |
| H27.02 | ICD10CM | Covered |
| H27.03 | ICD10CM | Covered |
| H27.111 | ICD10CM | Covered |
| H27.112 | ICD10CM | Covered |
| H27.113 | ICD10CM | Covered |
| H27.121 | ICD10CM | Covered |
| H27.122 | ICD10CM | Covered |
| H27.123 | ICD10CM | Covered |
| H27.131 | ICD10CM | Covered |
| H27.132 | ICD10CM | Covered |
| H27.133 | ICD10CM | Covered |
| H27.8 | ICD10CM | Covered |
| H27.9 | ICD10CM | Covered |
| H33.121 | ICD10CM | Covered |
| H33.122 | ICD10CM | Covered |
| H33.123 | ICD10CM | Covered |
| H40.1411 | ICD10CM | Covered |
| H40.1412 | ICD10CM | Covered |
| H40.1413 | ICD10CM | Covered |
| H40.1414 | ICD10CM | Covered |
| H40.1421 | ICD10CM | Covered |
| H40.1422 | ICD10CM | Covered |
| H40.1423 | ICD10CM | Covered |
| H40.1424 | ICD10CM | Covered |
| H40.1431 | ICD10CM | Covered |
| H40.1432 | ICD10CM | Covered |
| H40.1433 | ICD10CM | Covered |
| H40.1434 | ICD10CM | Covered |
| H40.40X0 | ICD10CM | Covered |
| H40.51X0 | ICD10CM | Covered |
| H40.51X1 | ICD10CM | Covered |
| H40.51X2 | ICD10CM | Covered |
| H40.51X3 | ICD10CM | Covered |
| H40.51X4 | ICD10CM | Covered |
| H40.52X0 | ICD10CM | Covered |
| H40.52X1 | ICD10CM | Covered |
| H40.52X2 | ICD10CM | Covered |
| H40.52X3 | ICD10CM | Covered |
| H40.52X4 | ICD10CM | Covered |
| H40.53X0 | ICD10CM | Covered |
| H40.53X1 | ICD10CM | Covered |
| H40.53X2 | ICD10CM | Covered |
| H40.53X3 | ICD10CM | Covered |
| H40.53X4 | ICD10CM | Covered |
| H40.841 | ICD10CM | Covered |
| H40.842 | ICD10CM | Covered |
| H40.843 | ICD10CM | Covered |
| H40.89 | ICD10CM | Covered |
| H44.001 | ICD10CM | Covered |
| H44.002 | ICD10CM | Covered |
| H44.003 | ICD10CM | Covered |
| H44.011 | ICD10CM | Covered |
| H44.012 | ICD10CM | Covered |
| H44.013 | ICD10CM | Covered |
| H44.021 | ICD10CM | Covered |
| H44.022 | ICD10CM | Covered |
| H44.023 | ICD10CM | Covered |
| H44.111 | ICD10CM | Covered |
| H44.112 | ICD10CM | Covered |
| H44.113 | ICD10CM | Covered |
| H44.121 | ICD10CM | Covered |
| H44.122 | ICD10CM | Covered |
| H44.123 | ICD10CM | Covered |
| H44.131 | ICD10CM | Covered |
| H44.132 | ICD10CM | Covered |
| H44.133 | ICD10CM | Covered |
| H44.19 | 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 |
| S02.31XA | ICD10CM | Covered |
| S02.31XB | ICD10CM | Covered |
| S02.32XA | ICD10CM | Covered |
| S02.32XB | ICD10CM | Covered |
| S02.42XA | ICD10CM | Covered |
| S02.42XB | ICD10CM | Covered |
| S02.81XA | ICD10CM | Covered |
| S02.81XB | ICD10CM | Covered |
| S02.82XA | ICD10CM | Covered |
| S02.82XB | ICD10CM | Covered |
| S05.01XA | ICD10CM | Covered |
| S05.02XA | ICD10CM | Covered |
| S05.90XA | ICD10CM | Covered |
| T26.01XA | ICD10CM | Covered |
| T26.02XA | ICD10CM | Covered |
| T26.11XA | ICD10CM | Covered |
| T26.12XA | ICD10CM | Covered |
| T26.21XA | ICD10CM | Covered |
| T26.22XA | ICD10CM | Covered |
| T26.31XA | ICD10CM | Covered |
| T26.32XA | ICD10CM | Covered |
| T26.40XA | ICD10CM | Covered |
| T26.41XA | ICD10CM | Covered |
| T26.42XA | ICD10CM | Covered |