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 1,703 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 92201 | HCPCS | Covered |
| 92202 | HCPCS | Covered |
| 92227 | HCPCS | Covered |
| 92228 | HCPCS | Covered |
| 92250 | HCPCS | Covered |
| A18.51 | ICD10CM | Covered |
| A18.53 | ICD10CM | Covered |
| A18.54 | ICD10CM | Covered |
| A52.15 | ICD10CM | Covered |
| B20 | ICD10CM | Covered |
| B39.9 | ICD10CM | Covered |
| B58.01 | ICD10CM | Covered |
| B58.09 | ICD10CM | Covered |
| C69.01 | ICD10CM | Covered |
| C69.02 | ICD10CM | Covered |
| C69.11 | ICD10CM | Covered |
| C69.12 | ICD10CM | Covered |
| C69.20 | ICD10CM | Covered |
| C69.21 | ICD10CM | Covered |
| C69.22 | ICD10CM | Covered |
| C69.30 | ICD10CM | Covered |
| C69.31 | ICD10CM | Covered |
| C69.32 | ICD10CM | Covered |
| C69.40 | 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 |
| C79.32 | ICD10CM | Covered |
| C79.49 | ICD10CM | Covered |
| C79.89 | ICD10CM | Covered |
| D09.21 | ICD10CM | Covered |
| D09.22 | ICD10CM | Covered |
| D31.20 | ICD10CM | Covered |
| D31.21 | ICD10CM | Covered |
| D31.22 | ICD10CM | Covered |
| D31.30 | ICD10CM | Covered |
| D31.31 | ICD10CM | Covered |
| D31.32 | ICD10CM | Covered |
| D31.41 | ICD10CM | Covered |
| D31.42 | ICD10CM | Covered |
| D33.3 | ICD10CM | Covered |
| D48.7 | ICD10CM | Covered |
| D49.81 | ICD10CM | Covered |
| D49.89 | ICD10CM | Covered |
| D57.00 | 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 |
| D57.20 | ICD10CM | Covered |
| D57.211 | ICD10CM | Covered |
| D57.212 | ICD10CM | Covered |
| D57.213 | ICD10CM | Covered |
| D57.214 | ICD10CM | Covered |
| D57.218 | ICD10CM | Covered |
| D57.219 | ICD10CM | Covered |
| D57.80 | ICD10CM | Covered |
| D57.811 | ICD10CM | Covered |
| D57.812 | ICD10CM | Covered |
| D57.813 | ICD10CM | Covered |
| D57.814 | ICD10CM | Covered |
| D57.818 | ICD10CM | Covered |
| E08.00 | ICD10CM | Covered |
| E08.01 | ICD10CM | Covered |
| E08.10 | ICD10CM | Covered |
| E08.11 | ICD10CM | Covered |
| E08.21 | ICD10CM | Covered |
| E08.22 | ICD10CM | Covered |
| E08.29 | ICD10CM | Covered |
| E08.311 | ICD10CM | Covered |
| E08.319 | ICD10CM | Covered |
| E08.3211 | ICD10CM | Covered |
| E08.3212 | ICD10CM | Covered |
| E08.3213 | ICD10CM | Covered |
| E08.3291 | ICD10CM | Covered |
| E08.3292 | ICD10CM | Covered |
| E08.3293 | ICD10CM | Covered |
| E08.3311 | ICD10CM | Covered |
| E08.3312 | ICD10CM | Covered |
| E08.3313 | ICD10CM | Covered |
| E08.3391 | ICD10CM | Covered |
| E08.3392 | ICD10CM | Covered |
| E08.3393 | ICD10CM | Covered |
| E08.3411 | ICD10CM | Covered |
| E08.3412 | ICD10CM | Covered |
| E08.3413 | ICD10CM | Covered |
| E08.3491 | ICD10CM | Covered |
| E08.3492 | ICD10CM | Covered |
| E08.3493 | ICD10CM | Covered |
| E08.3511 | ICD10CM | Covered |
| E08.3512 | ICD10CM | Covered |
| E08.3513 | ICD10CM | Covered |
| E08.3521 | ICD10CM | Covered |
| E08.3522 | ICD10CM | Covered |
| E08.3523 | ICD10CM | Covered |
| E08.3531 | ICD10CM | Covered |
| E08.3532 | ICD10CM | Covered |
| E08.3533 | ICD10CM | Covered |
| E08.3541 | ICD10CM | Covered |
| E08.3542 | ICD10CM | Covered |
| E08.3543 | ICD10CM | Covered |
| E08.3551 | ICD10CM | Covered |
| E08.3552 | ICD10CM | Covered |
| E08.3553 | ICD10CM | Covered |
| E08.3591 | ICD10CM | Covered |
| E08.3592 | ICD10CM | Covered |
| E08.3593 | ICD10CM | Covered |
| E08.36 | ICD10CM | Covered |
| E08.37X1 | ICD10CM | Covered |
| E08.37X2 | ICD10CM | Covered |
| E08.37X3 | ICD10CM | Covered |
| E08.39 | ICD10CM | Covered |
| E08.40 | ICD10CM | Covered |
| E08.41 | ICD10CM | Covered |
| E08.42 | ICD10CM | Covered |
| E08.43 | ICD10CM | Covered |
| E08.44 | ICD10CM | Covered |
| E08.49 | ICD10CM | Covered |
| E08.51 | ICD10CM | Covered |
| E08.52 | ICD10CM | Covered |
| E08.59 | ICD10CM | Covered |
| E08.610 | ICD10CM | Covered |
| E08.618 | ICD10CM | Covered |
| E08.620 | ICD10CM | Covered |
| E08.621 | ICD10CM | Covered |
| E08.622 | ICD10CM | Covered |
| E08.628 | ICD10CM | Covered |
| E08.630 | ICD10CM | Covered |
| E08.638 | ICD10CM | Covered |
| E08.641 | ICD10CM | Covered |
| E08.649 | ICD10CM | Covered |
| E08.65 | ICD10CM | Covered |
| E08.69 | ICD10CM | Covered |
| E08.8 | ICD10CM | Covered |
| E08.9 | ICD10CM | Covered |
| E09.00 | ICD10CM | Covered |
| E09.01 | ICD10CM | Covered |
| E09.10 | ICD10CM | Covered |
| E09.11 | ICD10CM | Covered |
| E09.21 | ICD10CM | Covered |
| E09.22 | ICD10CM | Covered |
| E09.29 | ICD10CM | Covered |
| E09.311 | ICD10CM | Covered |
| E09.319 | ICD10CM | Covered |
| E09.3211 | ICD10CM | Covered |
| E09.3212 | ICD10CM | Covered |
| E09.3213 | ICD10CM | Covered |
| E09.3291 | ICD10CM | Covered |
| E09.3292 | ICD10CM | Covered |
| E09.3293 | ICD10CM | Covered |
| E09.3311 | ICD10CM | Covered |
| E09.3312 | ICD10CM | Covered |
| E09.3313 | ICD10CM | Covered |
| E09.3391 | ICD10CM | Covered |
| E09.3392 | ICD10CM | Covered |
| E09.3393 | ICD10CM | Covered |
| E09.3411 | ICD10CM | Covered |
| E09.3412 | ICD10CM | Covered |
| E09.3413 | ICD10CM | Covered |
| E09.3491 | ICD10CM | Covered |
| E09.3492 | ICD10CM | Covered |
| E09.3493 | ICD10CM | Covered |
| E09.3511 | ICD10CM | Covered |
| E09.3512 | ICD10CM | Covered |
| E09.3513 | ICD10CM | Covered |
| E09.3521 | ICD10CM | Covered |
| E09.3522 | ICD10CM | Covered |
| E09.3523 | ICD10CM | Covered |
| E09.3531 | ICD10CM | Covered |
| E09.3532 | ICD10CM | Covered |
| E09.3533 | ICD10CM | Covered |
| E09.3541 | ICD10CM | Covered |
| E09.3542 | ICD10CM | Covered |
| E09.3543 | ICD10CM | Covered |
| E09.3551 | ICD10CM | Covered |
| E09.3552 | ICD10CM | Covered |
| E09.3553 | ICD10CM | Covered |
| E09.3591 | ICD10CM | Covered |
| E09.3592 | ICD10CM | Covered |
| E09.3593 | ICD10CM | Covered |
| E09.36 | ICD10CM | Covered |
| E09.37X1 | ICD10CM | Covered |
| E09.37X2 | ICD10CM | Covered |
| E09.37X3 | ICD10CM | Covered |
| E09.39 | ICD10CM | Covered |
| E09.41 | ICD10CM | Covered |
| E09.42 | ICD10CM | Covered |
| E09.43 | ICD10CM | Covered |
| E09.44 | ICD10CM | Covered |
| E09.49 | ICD10CM | Covered |
| E09.51 | ICD10CM | Covered |
| E09.52 | ICD10CM | Covered |
| E09.59 | ICD10CM | Covered |
| E09.610 | ICD10CM | Covered |
| E09.618 | ICD10CM | Covered |
| E09.620 | ICD10CM | Covered |
| E09.621 | ICD10CM | Covered |
| E09.622 | ICD10CM | Covered |
| E09.628 | ICD10CM | Covered |
| E09.630 | ICD10CM | Covered |
| E09.638 | ICD10CM | Covered |
| E09.641 | ICD10CM | Covered |
| E09.649 | ICD10CM | Covered |
| E09.65 | ICD10CM | Covered |
| E09.69 | ICD10CM | Covered |
| E09.8 | ICD10CM | Covered |
| E09.9 | ICD10CM | Covered |
| E10.10 | ICD10CM | Covered |
| E10.11 | ICD10CM | Covered |
| E10.21 | ICD10CM | Covered |
| E10.22 | ICD10CM | Covered |
| E10.29 | ICD10CM | Covered |
| E10.311 | ICD10CM | Covered |
| E10.319 | ICD10CM | Covered |
| E10.3211 | ICD10CM | Covered |
| E10.3212 | ICD10CM | Covered |
| E10.3213 | ICD10CM | Covered |
| E10.3219 | ICD10CM | Covered |
| E10.3291 | ICD10CM | Covered |
| E10.3292 | ICD10CM | Covered |
| E10.3293 | ICD10CM | Covered |
| E10.3299 | ICD10CM | Covered |
| E10.3311 | ICD10CM | Covered |
| E10.3312 | ICD10CM | Covered |
| E10.3313 | ICD10CM | Covered |
| E10.3319 | ICD10CM | Covered |
| E10.3391 | ICD10CM | Covered |
| E10.3392 | ICD10CM | Covered |
| E10.3393 | ICD10CM | Covered |
| E10.3399 | ICD10CM | Covered |
| E10.3411 | ICD10CM | Covered |
| E10.3412 | ICD10CM | Covered |
| E10.3413 | ICD10CM | Covered |
| E10.3419 | ICD10CM | Covered |
| E10.3491 | ICD10CM | Covered |
| E10.3492 | ICD10CM | Covered |
| E10.3493 | ICD10CM | Covered |
| E10.3499 | ICD10CM | Covered |
| E10.3511 | ICD10CM | Covered |
| E10.3512 | ICD10CM | Covered |
| E10.3513 | ICD10CM | Covered |
| E10.3521 | ICD10CM | Covered |
| E10.3522 | ICD10CM | Covered |
| E10.3523 | ICD10CM | Covered |
| E10.3531 | ICD10CM | Covered |
| E10.3532 | ICD10CM | Covered |
| E10.3533 | ICD10CM | Covered |
| E10.3541 | ICD10CM | Covered |
| E10.3542 | ICD10CM | Covered |
| E10.3543 | ICD10CM | Covered |
| E10.3551 | ICD10CM | Covered |
| E10.3552 | ICD10CM | Covered |
| E10.3553 | ICD10CM | Covered |
| E10.3591 | ICD10CM | Covered |
| E10.3592 | ICD10CM | Covered |
| E10.3593 | ICD10CM | Covered |
| E10.36 | ICD10CM | Covered |
| E10.37X1 | ICD10CM | Covered |
| E10.37X2 | ICD10CM | Covered |
| E10.37X3 | ICD10CM | Covered |
| E10.39 | ICD10CM | Covered |
| E10.641 | ICD10CM | Covered |
| E10.65 | ICD10CM | Covered |
| E10.69 | ICD10CM | Covered |
| E10.9 | ICD10CM | Covered |
| E11.00 | ICD10CM | Covered |
| E11.01 | ICD10CM | Covered |
| E11.21 | ICD10CM | Covered |
| E11.22 | ICD10CM | Covered |
| E11.29 | ICD10CM | Covered |
| E11.311 | ICD10CM | Covered |
| E11.319 | ICD10CM | Covered |
| E11.3211 | ICD10CM | Covered |
| E11.3212 | ICD10CM | Covered |
| E11.3213 | ICD10CM | Covered |
| E11.3291 | ICD10CM | Covered |
| E11.3292 | ICD10CM | Covered |
| E11.3293 | ICD10CM | Covered |
| E11.3311 | ICD10CM | Covered |
| E11.3312 | ICD10CM | Covered |
| E11.3313 | ICD10CM | Covered |
| E11.3391 | ICD10CM | Covered |
| E11.3392 | ICD10CM | Covered |
| E11.3393 | ICD10CM | Covered |
| E11.3411 | ICD10CM | Covered |
| E11.3412 | ICD10CM | Covered |
| E11.3413 | ICD10CM | Covered |
| E11.3491 | ICD10CM | Covered |
| E11.3492 | ICD10CM | Covered |
| E11.3493 | ICD10CM | Covered |
| E11.3511 | ICD10CM | Covered |
| E11.3512 | ICD10CM | Covered |
| E11.3513 | ICD10CM | Covered |
| E11.3521 | ICD10CM | Covered |
| E11.3522 | ICD10CM | Covered |
| E11.3523 | ICD10CM | Covered |
| E11.3531 | ICD10CM | Covered |
| E11.3532 | ICD10CM | Covered |
| E11.3533 | ICD10CM | Covered |
| E11.3541 | ICD10CM | Covered |
| E11.3542 | ICD10CM | Covered |
| E11.3543 | ICD10CM | Covered |
| E11.3551 | ICD10CM | Covered |
| E11.3552 | ICD10CM | Covered |
| E11.3553 | ICD10CM | Covered |
| E11.3591 | ICD10CM | Covered |
| E11.3592 | ICD10CM | Covered |
| E11.3593 | ICD10CM | Covered |
| E11.36 | ICD10CM | Covered |
| E11.37X1 | ICD10CM | Covered |
| E11.37X2 | ICD10CM | Covered |
| E11.37X3 | ICD10CM | Covered |
| E11.39 | ICD10CM | Covered |
| E11.641 | ICD10CM | Covered |
| E11.65 | ICD10CM | Covered |
| E11.9 | ICD10CM | Covered |
| E13.00 | ICD10CM | Covered |
| E13.01 | ICD10CM | Covered |
| E13.10 | ICD10CM | Covered |
| E13.11 | ICD10CM | Covered |
| E13.21 | ICD10CM | Covered |
| E13.22 | ICD10CM | Covered |
| E13.29 | ICD10CM | Covered |
| E13.311 | ICD10CM | Covered |
| E13.319 | ICD10CM | Covered |
| E13.3211 | ICD10CM | Covered |
| E13.3212 | ICD10CM | Covered |
| E13.3213 | ICD10CM | Covered |
| E13.3291 | ICD10CM | Covered |
| E13.3292 | ICD10CM | Covered |
| E13.3293 | ICD10CM | Covered |
| E13.3311 | ICD10CM | Covered |
| E13.3312 | ICD10CM | Covered |
| E13.3313 | ICD10CM | Covered |
| E13.3391 | ICD10CM | Covered |
| E13.3392 | ICD10CM | Covered |
| E13.3393 | ICD10CM | Covered |
| E13.3411 | ICD10CM | Covered |
| E13.3412 | ICD10CM | Covered |
| E13.3413 | ICD10CM | Covered |
| E13.3491 | ICD10CM | Covered |
| E13.3492 | ICD10CM | Covered |
| E13.3493 | ICD10CM | Covered |
| E13.3511 | ICD10CM | Covered |
| E13.3512 | ICD10CM | Covered |
| E13.3513 | ICD10CM | Covered |
| E13.3521 | ICD10CM | Covered |
| E13.3522 | ICD10CM | Covered |
| E13.3523 | ICD10CM | Covered |
| E13.3531 | ICD10CM | Covered |
| E13.3532 | ICD10CM | Covered |
| E13.3533 | ICD10CM | Covered |
| E13.3541 | ICD10CM | Covered |
| E13.3542 | ICD10CM | Covered |
| E13.3543 | ICD10CM | Covered |
| E13.3551 | ICD10CM | Covered |
| E13.3552 | ICD10CM | Covered |
| E13.3553 | ICD10CM | Covered |
| E13.3591 | ICD10CM | Covered |
| E13.3592 | ICD10CM | Covered |
| E13.3593 | ICD10CM | Covered |
| E13.36 | ICD10CM | Covered |
| E13.37X1 | ICD10CM | Covered |
| E13.37X2 | ICD10CM | Covered |
| E13.37X3 | ICD10CM | Covered |
| E13.39 | ICD10CM | Covered |
| E13.40 | ICD10CM | Covered |
| E13.41 | ICD10CM | Covered |
| E13.42 | ICD10CM | Covered |
| E13.43 | ICD10CM | Covered |
| E13.44 | ICD10CM | Covered |
| E13.49 | ICD10CM | Covered |
| E13.51 | ICD10CM | Covered |
| E13.52 | ICD10CM | Covered |
| E13.59 | ICD10CM | Covered |
| E13.610 | ICD10CM | Covered |
| E13.618 | ICD10CM | Covered |
| E13.620 | ICD10CM | Covered |
| E13.621 | ICD10CM | Covered |
| E13.622 | ICD10CM | Covered |
| E13.628 | ICD10CM | Covered |
| E13.630 | ICD10CM | Covered |
| E13.638 | ICD10CM | Covered |
| E13.641 | ICD10CM | Covered |
| E13.649 | ICD10CM | Covered |
| E13.65 | ICD10CM | Covered |
| E13.69 | ICD10CM | Covered |
| E13.8 | ICD10CM | Covered |
| E13.9 | ICD10CM | Covered |
| E70.20 | ICD10CM | Covered |
| E70.21 | ICD10CM | Covered |
| E70.29 | ICD10CM | Covered |
| E70.30 | ICD10CM | Covered |
| E70.310 | ICD10CM | Covered |
| E70.311 | ICD10CM | Covered |
| E70.318 | ICD10CM | Covered |
| E70.319 | ICD10CM | Covered |
| E70.320 | ICD10CM | Covered |
| E70.321 | ICD10CM | Covered |
| E70.328 | ICD10CM | Covered |
| E70.329 | ICD10CM | Covered |
| E70.330 | ICD10CM | Covered |
| E70.331 | ICD10CM | Covered |
| E70.338 | ICD10CM | Covered |
| E70.339 | ICD10CM | Covered |
| E70.39 | ICD10CM | Covered |
| E70.5 | ICD10CM | Covered |
| E70.81 | ICD10CM | Covered |
| E70.89 | ICD10CM | Covered |
| E70.9 | ICD10CM | Covered |
| E78.71 | ICD10CM | Covered |
| E78.72 | ICD10CM | Covered |
| G35.A | ICD10CM | Covered |
| G35.B0 | ICD10CM | Covered |
| G35.B1 | ICD10CM | Covered |
| G35.B2 | ICD10CM | Covered |
| G35.C0 | ICD10CM | Covered |
| G35.C1 | ICD10CM | Covered |
| G35.C2 | ICD10CM | Covered |
| G45.3 | 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 |
| H05.89 | ICD10CM | Covered |
| H15.001 | ICD10CM | Covered |
| H15.002 | ICD10CM | Covered |
| H15.003 | ICD10CM | Covered |
| H15.031 | ICD10CM | Covered |
| H15.032 | ICD10CM | Covered |
| H15.033 | 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 |
| H15.841 | ICD10CM | Covered |
| H15.842 | ICD10CM | Covered |
| H15.843 | ICD10CM | Covered |
| H16.241 | ICD10CM | Covered |
| H16.242 | ICD10CM | Covered |
| H16.243 | 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 |
| H20.11 | 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 |
| H21.82 | ICD10CM | Covered |
| H21.89 | ICD10CM | Covered |
| H21.9 | ICD10CM | Covered |
| H22 | ICD10CM | Covered |
| H27.10 | ICD10CM | Covered |
| H27.111 | ICD10CM | Covered |
| H27.112 | ICD10CM | Covered |
| H27.113 | ICD10CM | Covered |
| H27.131 | ICD10CM | Covered |
| H27.132 | ICD10CM | Covered |
| H27.133 | ICD10CM | Covered |
| H30.001 | ICD10CM | Covered |
| H30.002 | ICD10CM | Covered |
| H30.003 | ICD10CM | Covered |
| H30.011 | ICD10CM | Covered |
| H30.012 | ICD10CM | Covered |
| H30.013 | ICD10CM | Covered |
| H30.021 | ICD10CM | Covered |
| H30.022 | ICD10CM | Covered |
| H30.023 | ICD10CM | Covered |
| H30.031 | ICD10CM | Covered |
| H30.032 | ICD10CM | Covered |
| H30.033 | ICD10CM | Covered |
| H30.041 | ICD10CM | Covered |
| H30.042 | ICD10CM | Covered |
| H30.043 | ICD10CM | Covered |
| H30.101 | ICD10CM | Covered |
| H30.102 | ICD10CM | Covered |
| H30.103 | ICD10CM | Covered |
| H30.111 | ICD10CM | Covered |
| H30.112 | ICD10CM | Covered |
| H30.113 | ICD10CM | Covered |
| H30.121 | ICD10CM | Covered |
| H30.122 | ICD10CM | Covered |
| H30.123 | ICD10CM | Covered |
| H30.131 | ICD10CM | Covered |
| H30.132 | ICD10CM | Covered |
| H30.133 | ICD10CM | Covered |
| H30.141 | ICD10CM | Covered |
| H30.142 | ICD10CM | Covered |
| H30.143 | ICD10CM | Covered |
| H30.21 | ICD10CM | Covered |
| H30.22 | ICD10CM | Covered |
| H30.23 | ICD10CM | Covered |
| H30.811 | ICD10CM | Covered |
| H30.812 | ICD10CM | Covered |
| H30.813 | ICD10CM | Covered |
| H30.891 | ICD10CM | Covered |
| H30.892 | ICD10CM | Covered |
| H30.893 | ICD10CM | Covered |
| H30.91 | ICD10CM | Covered |
| H30.92 | ICD10CM | Covered |
| H30.93 | ICD10CM | Covered |
| H31.001 | ICD10CM | Covered |
| H31.002 | ICD10CM | Covered |
| H31.003 | ICD10CM | Covered |
| H31.011 | ICD10CM | Covered |
| H31.012 | ICD10CM | Covered |
| H31.013 | ICD10CM | Covered |
| H31.021 | ICD10CM | Covered |
| H31.022 | ICD10CM | Covered |
| H31.023 | ICD10CM | Covered |
| H31.091 | ICD10CM | Covered |
| H31.092 | ICD10CM | Covered |
| H31.093 | ICD10CM | Covered |
| H31.101 | ICD10CM | Covered |
| H31.102 | ICD10CM | Covered |
| H31.103 | ICD10CM | Covered |
| H31.111 | ICD10CM | Covered |
| H31.112 | ICD10CM | Covered |
| H31.113 | ICD10CM | Covered |
| H31.121 | ICD10CM | Covered |
| H31.122 | ICD10CM | Covered |
| H31.123 | ICD10CM | Covered |
| H31.20 | ICD10CM | Covered |
| H31.21 | ICD10CM | Covered |
| H31.22 | ICD10CM | Covered |
| H31.23 | ICD10CM | Covered |
| H31.29 | ICD10CM | Covered |
| H31.301 | ICD10CM | Covered |
| H31.302 | ICD10CM | Covered |
| H31.303 | ICD10CM | Covered |
| H31.311 | ICD10CM | Covered |
| H31.312 | ICD10CM | Covered |
| H31.313 | ICD10CM | Covered |
| H31.321 | ICD10CM | Covered |
| H31.322 | ICD10CM | Covered |
| H31.323 | ICD10CM | Covered |
| H31.401 | ICD10CM | Covered |
| H31.402 | ICD10CM | Covered |
| H31.403 | ICD10CM | Covered |
| H31.411 | ICD10CM | Covered |
| H31.412 | ICD10CM | Covered |
| H31.413 | ICD10CM | Covered |
| H31.421 | ICD10CM | Covered |
| H31.422 | ICD10CM | Covered |
| H31.423 | ICD10CM | Covered |
| H31.8 | ICD10CM | Covered |
| H31.9 | ICD10CM | Covered |
| H32 | ICD10CM | Covered |
| H33.001 | ICD10CM | Covered |
| H33.002 | ICD10CM | Covered |
| H33.003 | ICD10CM | Covered |
| H33.011 | ICD10CM | Covered |
| H33.012 | ICD10CM | Covered |
| H33.013 | ICD10CM | Covered |
| H33.021 | ICD10CM | Covered |
| H33.022 | ICD10CM | Covered |
| H33.023 | ICD10CM | Covered |
| H33.031 | ICD10CM | Covered |
| H33.032 | ICD10CM | Covered |
| H33.033 | ICD10CM | Covered |
| H33.041 | ICD10CM | Covered |
| H33.042 | ICD10CM | Covered |
| H33.043 | ICD10CM | Covered |
| H33.051 | ICD10CM | Covered |
| H33.052 | ICD10CM | Covered |
| H33.053 | ICD10CM | Covered |
| H33.101 | ICD10CM | Covered |
| H33.102 | ICD10CM | Covered |
| H33.103 | ICD10CM | Covered |
| H33.111 | ICD10CM | Covered |
| H33.112 | ICD10CM | Covered |
| H33.113 | ICD10CM | Covered |
| H33.121 | ICD10CM | Covered |
| H33.122 | ICD10CM | Covered |
| H33.123 | ICD10CM | Covered |
| H33.191 | ICD10CM | Covered |
| H33.192 | ICD10CM | Covered |
| H33.193 | ICD10CM | Covered |
| H33.20 | ICD10CM | Covered |
| H33.21 | ICD10CM | Covered |
| H33.22 | ICD10CM | Covered |
| H33.23 | ICD10CM | Covered |
| H33.301 | ICD10CM | Covered |
| H33.302 | ICD10CM | Covered |
| H33.303 | ICD10CM | Covered |
| H33.311 | ICD10CM | Covered |
| H33.312 | ICD10CM | Covered |
| H33.313 | ICD10CM | Covered |
| H33.321 | ICD10CM | Covered |
| H33.322 | ICD10CM | Covered |
| H33.323 | ICD10CM | Covered |
| H33.331 | ICD10CM | Covered |
| H33.332 | ICD10CM | Covered |
| H33.333 | ICD10CM | Covered |
| H33.41 | ICD10CM | Covered |
| H33.42 | ICD10CM | Covered |
| H33.43 | ICD10CM | Covered |
| H33.8 | 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 |
| H34.9 | ICD10CM | Covered |
| H35.00 | ICD10CM | Covered |
| H35.011 | ICD10CM | Covered |
| H35.012 | ICD10CM | Covered |
| H35.013 | ICD10CM | Covered |
| H35.021 | ICD10CM | Covered |
| H35.022 | ICD10CM | Covered |
| H35.023 | ICD10CM | Covered |
| H35.031 | ICD10CM | Covered |
| H35.032 | ICD10CM | Covered |
| H35.033 | ICD10CM | Covered |
| H35.041 | ICD10CM | Covered |
| H35.042 | ICD10CM | Covered |
| H35.043 | ICD10CM | Covered |
| H35.051 | ICD10CM | Covered |
| H35.052 | ICD10CM | Covered |
| H35.053 | ICD10CM | Covered |
| H35.059 | ICD10CM | Covered |
| H35.061 | ICD10CM | Covered |
| H35.062 | ICD10CM | Covered |
| H35.063 | ICD10CM | Covered |
| H35.071 | ICD10CM | Covered |
| H35.072 | ICD10CM | Covered |
| H35.073 | ICD10CM | Covered |
| H35.09 | ICD10CM | Covered |
| H35.101 | ICD10CM | Covered |
| H35.102 | ICD10CM | Covered |
| H35.103 | ICD10CM | Covered |
| H35.111 | ICD10CM | Covered |
| H35.112 | ICD10CM | Covered |
| H35.113 | ICD10CM | Covered |
| H35.121 | ICD10CM | Covered |
| H35.122 | ICD10CM | Covered |
| H35.123 | ICD10CM | Covered |
| H35.131 | ICD10CM | Covered |
| H35.132 | ICD10CM | Covered |
| H35.133 | ICD10CM | Covered |
| H35.141 | ICD10CM | Covered |
| H35.142 | ICD10CM | Covered |
| H35.143 | ICD10CM | Covered |
| H35.151 | ICD10CM | Covered |
| H35.152 | ICD10CM | Covered |
| H35.153 | ICD10CM | Covered |
| H35.161 | ICD10CM | Covered |
| H35.162 | ICD10CM | Covered |
| H35.163 | ICD10CM | Covered |
| H35.171 | ICD10CM | Covered |
| H35.172 | ICD10CM | Covered |
| H35.173 | ICD10CM | Covered |
| H35.21 | ICD10CM | Covered |
| H35.22 | ICD10CM | Covered |
| H35.23 | ICD10CM | Covered |
| H35.30 | ICD10CM | Covered |
| H35.3111 | ICD10CM | Covered |
| H35.3112 | ICD10CM | Covered |
| H35.3113 | ICD10CM | Covered |
| H35.3114 | ICD10CM | Covered |
| H35.3121 | ICD10CM | Covered |
| H35.3122 | ICD10CM | Covered |
| H35.3123 | ICD10CM | Covered |
| H35.3124 | ICD10CM | Covered |
| H35.3131 | ICD10CM | Covered |
| H35.3132 | ICD10CM | Covered |
| H35.3133 | ICD10CM | Covered |
| H35.3134 | ICD10CM | Covered |
| H35.3211 | ICD10CM | Covered |
| H35.3212 | ICD10CM | Covered |
| H35.3213 | ICD10CM | Covered |
| H35.3221 | ICD10CM | Covered |
| H35.3222 | ICD10CM | Covered |
| H35.3223 | ICD10CM | Covered |
| H35.3231 | ICD10CM | Covered |
| H35.3232 | ICD10CM | Covered |
| H35.3233 | ICD10CM | Covered |
| H35.33 | ICD10CM | Covered |
| H35.341 | ICD10CM | Covered |
| H35.342 | ICD10CM | Covered |
| H35.343 | ICD10CM | Covered |
| H35.351 | ICD10CM | Covered |
| H35.352 | ICD10CM | Covered |
| H35.353 | ICD10CM | Covered |
| H35.361 | ICD10CM | Covered |
| H35.362 | ICD10CM | Covered |
| H35.363 | ICD10CM | Covered |
| H35.371 | ICD10CM | Covered |
| H35.372 | ICD10CM | Covered |
| H35.373 | ICD10CM | Covered |
| H35.381 | ICD10CM | Covered |
| H35.382 | ICD10CM | Covered |
| H35.383 | ICD10CM | Covered |
| H35.40 | ICD10CM | Covered |
| H35.411 | ICD10CM | Covered |
| H35.412 | ICD10CM | Covered |
| H35.413 | ICD10CM | Covered |
| H35.421 | ICD10CM | Covered |
| H35.422 | ICD10CM | Covered |
| H35.423 | ICD10CM | Covered |
| H35.431 | ICD10CM | Covered |
| H35.432 | ICD10CM | Covered |
| H35.433 | ICD10CM | Covered |
| H35.441 | ICD10CM | Covered |
| H35.442 | ICD10CM | Covered |
| H35.443 | ICD10CM | Covered |
| H35.451 | ICD10CM | Covered |
| H35.452 | ICD10CM | Covered |
| H35.453 | ICD10CM | Covered |
| H35.461 | ICD10CM | Covered |
| H35.462 | ICD10CM | Covered |
| H35.463 | ICD10CM | Covered |
| H35.50 | ICD10CM | Covered |
| H35.51 | ICD10CM | Covered |
| H35.52 | ICD10CM | Covered |
| H35.53 | ICD10CM | Covered |
| H35.54 | ICD10CM | Covered |
| H35.61 | ICD10CM | Covered |
| H35.62 | ICD10CM | Covered |
| H35.63 | ICD10CM | Covered |
| H35.70 | ICD10CM | Covered |
| H35.711 | ICD10CM | Covered |
| H35.712 | ICD10CM | Covered |
| H35.713 | ICD10CM | Covered |
| H35.721 | ICD10CM | Covered |
| H35.722 | ICD10CM | Covered |
| H35.723 | ICD10CM | Covered |
| H35.731 | ICD10CM | Covered |
| H35.732 | ICD10CM | Covered |
| H35.733 | ICD10CM | Covered |
| H35.81 | ICD10CM | Covered |
| H35.82 | ICD10CM | Covered |
| H35.89 | ICD10CM | Covered |
| H35.9 | ICD10CM | Covered |
| H36.811 | ICD10CM | Covered |
| H36.812 | ICD10CM | Covered |
| H36.813 | ICD10CM | Covered |
| H36.821 | ICD10CM | Covered |
| H36.822 | ICD10CM | Covered |
| H36.823 | ICD10CM | Covered |
| H36.89 | ICD10CM | Covered |
| H40.001 | ICD10CM | Covered |
| H40.002 | ICD10CM | Covered |
| H40.003 | ICD10CM | Covered |
| H40.011 | ICD10CM | Covered |
| H40.012 | ICD10CM | Covered |
| H40.013 | ICD10CM | Covered |
| H40.021 | ICD10CM | Covered |
| H40.022 | ICD10CM | Covered |
| H40.023 | ICD10CM | Covered |
| H40.031 | ICD10CM | Covered |
| H40.032 | ICD10CM | Covered |
| H40.033 | ICD10CM | Covered |
| H40.041 | ICD10CM | Covered |
| H40.042 | ICD10CM | Covered |
| H40.043 | ICD10CM | Covered |
| H40.051 | ICD10CM | Covered |
| H40.052 | ICD10CM | Covered |
| H40.053 | ICD10CM | Covered |
| H40.10X1 | ICD10CM | Covered |
| H40.10X2 | ICD10CM | Covered |
| H40.10X3 | ICD10CM | Covered |
| H40.10X4 | ICD10CM | Covered |
| H40.1110 | ICD10CM | Covered |
| H40.1111 | ICD10CM | Covered |
| H40.1112 | ICD10CM | Covered |
| H40.1113 | ICD10CM | Covered |
| H40.1114 | ICD10CM | Covered |
| H40.1120 | ICD10CM | Covered |
| H40.1121 | ICD10CM | Covered |
| H40.1122 | ICD10CM | Covered |
| H40.1123 | ICD10CM | Covered |
| H40.1124 | ICD10CM | Covered |
| H40.1130 | ICD10CM | Covered |
| H40.1131 | ICD10CM | Covered |
| H40.1132 | ICD10CM | Covered |
| H40.1133 | ICD10CM | Covered |
| H40.1134 | ICD10CM | Covered |
| H40.1211 | ICD10CM | Covered |
| H40.1212 | ICD10CM | Covered |
| H40.1213 | ICD10CM | Covered |
| H40.1214 | ICD10CM | Covered |
| H40.1221 | ICD10CM | Covered |
| H40.1222 | ICD10CM | Covered |
| H40.1223 | ICD10CM | Covered |
| H40.1224 | ICD10CM | Covered |
| H40.1231 | ICD10CM | Covered |
| H40.1232 | ICD10CM | Covered |
| H40.1233 | ICD10CM | Covered |
| H40.1234 | ICD10CM | Covered |
| H40.1311 | ICD10CM | Covered |
| H40.1312 | ICD10CM | Covered |
| H40.1313 | ICD10CM | Covered |
| H40.1314 | ICD10CM | Covered |
| H40.1321 | ICD10CM | Covered |
| H40.1322 | ICD10CM | Covered |
| H40.1323 | ICD10CM | Covered |
| H40.1324 | ICD10CM | Covered |
| H40.1331 | ICD10CM | Covered |
| H40.1332 | ICD10CM | Covered |
| H40.1333 | ICD10CM | Covered |
| H40.1334 | 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 |
| H40.151 | ICD10CM | Covered |
| H40.152 | ICD10CM | Covered |
| H40.153 | ICD10CM | Covered |
| H40.20X1 | ICD10CM | Covered |
| H40.20X2 | ICD10CM | Covered |
| H40.20X3 | ICD10CM | Covered |
| H40.20X4 | ICD10CM | Covered |
| H40.211 | ICD10CM | Covered |
| H40.212 | ICD10CM | Covered |
| H40.213 | ICD10CM | Covered |
| H40.2211 | ICD10CM | Covered |
| H40.2212 | ICD10CM | Covered |
| H40.2213 | ICD10CM | Covered |
| H40.2214 | ICD10CM | Covered |
| H40.2221 | ICD10CM | Covered |
| H40.2222 | ICD10CM | Covered |
| H40.2223 | ICD10CM | Covered |
| H40.2224 | ICD10CM | Covered |
| H40.2231 | ICD10CM | Covered |
| H40.2232 | ICD10CM | Covered |
| H40.2233 | ICD10CM | Covered |
| H40.2234 | ICD10CM | Covered |
| H40.231 | ICD10CM | Covered |
| H40.232 | ICD10CM | Covered |
| H40.233 | ICD10CM | Covered |
| H40.241 | ICD10CM | Covered |
| H40.242 | ICD10CM | Covered |
| H40.243 | ICD10CM | Covered |
| H40.31X1 | ICD10CM | Covered |
| H40.31X2 | ICD10CM | Covered |
| H40.31X3 | ICD10CM | Covered |
| H40.31X4 | ICD10CM | Covered |
| H40.32X1 | ICD10CM | Covered |