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 1,405 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 0106T | HCPCS | Covered |
| 0107T | HCPCS | Covered |
| 0108T | HCPCS | Covered |
| 0109T | HCPCS | Covered |
| 0110T | HCPCS | Covered |
| 51784 | HCPCS | Covered |
| 51785 | HCPCS | Covered |
| 92265 | HCPCS | Covered |
| 95860 | HCPCS | Covered |
| 95861 | HCPCS | Covered |
| 95863 | HCPCS | Covered |
| 95864 | HCPCS | Covered |
| 95865 | HCPCS | Covered |
| 95866 | HCPCS | Covered |
| 95867 | HCPCS | Covered |
| 95868 | HCPCS | Covered |
| 95869 | HCPCS | Covered |
| 95870 | HCPCS | Covered |
| 95872 | HCPCS | Covered |
| 95874 | HCPCS | Covered |
| 95885 | HCPCS | Covered |
| 95886 | HCPCS | Covered |
| 95887 | HCPCS | Covered |
| 95905 | HCPCS | Covered |
| 95907 | HCPCS | Covered |
| 95908 | HCPCS | Covered |
| 95909 | HCPCS | Covered |
| 95910 | HCPCS | Covered |
| 95911 | HCPCS | Covered |
| 95912 | HCPCS | Covered |
| 95913 | HCPCS | Covered |
| 95933 | HCPCS | Covered |
| 95937 | HCPCS | Covered |
| A05.1 | ICD10CM | Covered |
| A17.83 | ICD10CM | Covered |
| A17.89 | ICD10CM | Covered |
| A35 | ICD10CM | Covered |
| A36.83 | ICD10CM | Covered |
| A39.82 | ICD10CM | Covered |
| A48.51 | ICD10CM | Covered |
| A48.52 | ICD10CM | Covered |
| A50.43 | ICD10CM | Covered |
| A50.44 | ICD10CM | Covered |
| A52.15 | ICD10CM | Covered |
| A69.22 | ICD10CM | Covered |
| B02.21 | ICD10CM | Covered |
| B02.22 | ICD10CM | Covered |
| B02.23 | ICD10CM | Covered |
| B26.84 | ICD10CM | Covered |
| B27.01 | ICD10CM | Covered |
| B27.11 | ICD10CM | Covered |
| B27.81 | ICD10CM | Covered |
| B91 | ICD10CM | Covered |
| C70.1 | ICD10CM | Covered |
| C72.0 | ICD10CM | Covered |
| C72.1 | ICD10CM | Covered |
| C72.21 | ICD10CM | Covered |
| C72.22 | ICD10CM | Covered |
| C72.31 | ICD10CM | Covered |
| C72.32 | ICD10CM | Covered |
| C72.41 | ICD10CM | Covered |
| C72.42 | ICD10CM | Covered |
| C72.59 | ICD10CM | Covered |
| D32.1 | ICD10CM | Covered |
| D33.3 | ICD10CM | Covered |
| D33.4 | ICD10CM | Covered |
| D86.82 | ICD10CM | Covered |
| E08.41 | ICD10CM | Covered |
| E08.42 | ICD10CM | Covered |
| E08.43 | ICD10CM | Covered |
| E08.44 | ICD10CM | Covered |
| E08.49 | ICD10CM | Covered |
| E08.610 | ICD10CM | Covered |
| E09.41 | ICD10CM | Covered |
| E09.42 | ICD10CM | Covered |
| E09.43 | ICD10CM | Covered |
| E09.44 | ICD10CM | Covered |
| E09.49 | ICD10CM | Covered |
| E09.610 | ICD10CM | Covered |
| E10.41 | ICD10CM | Covered |
| E10.42 | ICD10CM | Covered |
| E10.43 | ICD10CM | Covered |
| E10.44 | ICD10CM | Covered |
| E10.49 | ICD10CM | Covered |
| E10.610 | ICD10CM | Covered |
| E11.41 | ICD10CM | Covered |
| E11.42 | ICD10CM | Covered |
| E11.43 | ICD10CM | Covered |
| E11.44 | ICD10CM | Covered |
| E11.49 | ICD10CM | Covered |
| E11.610 | ICD10CM | Covered |
| E13.41 | ICD10CM | Covered |
| E13.42 | ICD10CM | Covered |
| E13.43 | ICD10CM | Covered |
| E13.44 | ICD10CM | Covered |
| E13.49 | ICD10CM | Covered |
| E13.610 | ICD10CM | Covered |
| E51.11 | ICD10CM | Covered |
| E53.1 | ICD10CM | Covered |
| E53.8 | ICD10CM | Covered |
| E56.0 | ICD10CM | Covered |
| E64.8 | ICD10CM | Covered |
| E71.314 | ICD10CM | Covered |
| E71.41 | ICD10CM | Covered |
| E71.42 | ICD10CM | Covered |
| E71.43 | ICD10CM | Covered |
| E71.440 | ICD10CM | Covered |
| E71.448 | ICD10CM | Covered |
| E74.02 | ICD10CM | Covered |
| E74.03 | ICD10CM | Covered |
| E74.04 | ICD10CM | Covered |
| E74.05 | ICD10CM | Covered |
| E74.09 | ICD10CM | Covered |
| E79.2 | ICD10CM | Covered |
| E85.1 | ICD10CM | Covered |
| F95.1 | ICD10CM | Covered |
| F95.2 | ICD10CM | Covered |
| G11.4 | ICD10CM | Covered |
| G12.0 | ICD10CM | Covered |
| G12.1 | ICD10CM | Covered |
| G12.20 | ICD10CM | Covered |
| G12.21 | ICD10CM | Covered |
| G12.22 | ICD10CM | Covered |
| G12.23 | ICD10CM | Covered |
| G12.24 | ICD10CM | Covered |
| G12.25 | ICD10CM | Covered |
| G12.29 | ICD10CM | Covered |
| G12.8 | ICD10CM | Covered |
| G12.9 | ICD10CM | Covered |
| G13.0 | ICD10CM | Covered |
| G14 | ICD10CM | Covered |
| G20.A1 | ICD10CM | Covered |
| G20.A2 | ICD10CM | Covered |
| G20.B1 | ICD10CM | Covered |
| G20.B2 | ICD10CM | Covered |
| G24.3 | ICD10CM | Covered |
| G24.4 | ICD10CM | Covered |
| G24.5 | ICD10CM | Covered |
| G24.8 | ICD10CM | Covered |
| G25.0 | ICD10CM | Covered |
| G32.0 | 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 |
| G35.D | ICD10CM | Covered |
| G37.3 | ICD10CM | Covered |
| G43.701 | ICD10CM | Covered |
| G43.709 | ICD10CM | Covered |
| G43.711 | ICD10CM | Covered |
| G43.719 | ICD10CM | Covered |
| G50.0 | ICD10CM | Covered |
| G50.1 | ICD10CM | Covered |
| G50.8 | ICD10CM | Covered |
| G51.1 | ICD10CM | Covered |
| G51.31 | ICD10CM | Covered |
| G51.32 | ICD10CM | Covered |
| G51.33 | ICD10CM | Covered |
| G51.8 | ICD10CM | Covered |
| G52.0 | ICD10CM | Covered |
| G52.1 | ICD10CM | Covered |
| G52.2 | ICD10CM | Covered |
| G52.3 | ICD10CM | Covered |
| G52.7 | ICD10CM | Covered |
| G52.8 | ICD10CM | Covered |
| G52.9 | ICD10CM | Covered |
| G53 | ICD10CM | Covered |
| G54.0 | ICD10CM | Covered |
| G54.1 | ICD10CM | Covered |
| G54.2 | ICD10CM | Covered |
| G54.3 | ICD10CM | Covered |
| G54.4 | ICD10CM | Covered |
| G54.5 | ICD10CM | Covered |
| G54.6 | ICD10CM | Covered |
| G54.7 | ICD10CM | Covered |
| G54.8 | ICD10CM | Covered |
| G54.9 | ICD10CM | Covered |
| G55 | ICD10CM | Covered |
| G56.01 | ICD10CM | Covered |
| G56.02 | ICD10CM | Covered |
| G56.03 | ICD10CM | Covered |
| G56.11 | ICD10CM | Covered |
| G56.12 | ICD10CM | Covered |
| G56.13 | ICD10CM | Covered |
| G56.21 | ICD10CM | Covered |
| G56.22 | ICD10CM | Covered |
| G56.23 | ICD10CM | Covered |
| G56.31 | ICD10CM | Covered |
| G56.32 | ICD10CM | Covered |
| G56.33 | ICD10CM | Covered |
| G56.41 | ICD10CM | Covered |
| G56.42 | ICD10CM | Covered |
| G56.43 | ICD10CM | Covered |
| G56.81 | ICD10CM | Covered |
| G56.82 | ICD10CM | Covered |
| G56.83 | ICD10CM | Covered |
| G56.91 | ICD10CM | Covered |
| G56.92 | ICD10CM | Covered |
| G56.93 | ICD10CM | Covered |
| G57.01 | ICD10CM | Covered |
| G57.02 | ICD10CM | Covered |
| G57.03 | ICD10CM | Covered |
| G57.11 | ICD10CM | Covered |
| G57.12 | ICD10CM | Covered |
| G57.13 | ICD10CM | Covered |
| G57.21 | ICD10CM | Covered |
| G57.22 | ICD10CM | Covered |
| G57.23 | ICD10CM | Covered |
| G57.31 | ICD10CM | Covered |
| G57.32 | ICD10CM | Covered |
| G57.33 | ICD10CM | Covered |
| G57.41 | ICD10CM | Covered |
| G57.42 | ICD10CM | Covered |
| G57.43 | ICD10CM | Covered |
| G57.51 | ICD10CM | Covered |
| G57.52 | ICD10CM | Covered |
| G57.53 | ICD10CM | Covered |
| G57.61 | ICD10CM | Covered |
| G57.62 | ICD10CM | Covered |
| G57.63 | ICD10CM | Covered |
| G57.81 | ICD10CM | Covered |
| G57.82 | ICD10CM | Covered |
| G57.83 | ICD10CM | Covered |
| G57.91 | ICD10CM | Covered |
| G57.92 | ICD10CM | Covered |
| G57.93 | ICD10CM | Covered |
| G58.0 | ICD10CM | Covered |
| G58.7 | ICD10CM | Covered |
| G58.8 | ICD10CM | Covered |
| G58.9 | ICD10CM | Covered |
| G59 | ICD10CM | Covered |
| G60.0 | ICD10CM | Covered |
| G60.1 | ICD10CM | Covered |
| G60.2 | ICD10CM | Covered |
| G60.3 | ICD10CM | Covered |
| G60.8 | ICD10CM | Covered |
| G60.9 | ICD10CM | Covered |
| G61.0 | ICD10CM | Covered |
| G61.1 | ICD10CM | Covered |
| G61.81 | ICD10CM | Covered |
| G61.82 | ICD10CM | Covered |
| G61.89 | ICD10CM | Covered |
| G62.0 | ICD10CM | Covered |
| G62.1 | ICD10CM | Covered |
| G62.2 | ICD10CM | Covered |
| G62.81 | ICD10CM | Covered |
| G62.82 | ICD10CM | Covered |
| G62.89 | ICD10CM | Covered |
| G63 | ICD10CM | Covered |
| G64 | ICD10CM | Covered |
| G65.0 | ICD10CM | Covered |
| G65.1 | ICD10CM | Covered |
| G65.2 | ICD10CM | Covered |
| G70.00 | ICD10CM | Covered |
| G70.01 | ICD10CM | Covered |
| G70.1 | ICD10CM | Covered |
| G70.2 | ICD10CM | Covered |
| G70.80 | ICD10CM | Covered |
| G70.81 | ICD10CM | Covered |
| G70.89 | ICD10CM | Covered |
| G70.9 | ICD10CM | Covered |
| G71.00 | ICD10CM | Covered |
| G71.01 | ICD10CM | Covered |
| G71.02 | ICD10CM | Covered |
| G71.031 | ICD10CM | Covered |
| G71.032 | ICD10CM | Covered |
| G71.033 | ICD10CM | Covered |
| G71.0341 | ICD10CM | Covered |
| G71.0342 | ICD10CM | Covered |
| G71.0349 | ICD10CM | Covered |
| G71.035 | ICD10CM | Covered |
| G71.038 | ICD10CM | Covered |
| G71.09 | ICD10CM | Covered |
| G71.11 | ICD10CM | Covered |
| G71.12 | ICD10CM | Covered |
| G71.13 | ICD10CM | Covered |
| G71.14 | ICD10CM | Covered |
| G71.19 | ICD10CM | Covered |
| G71.20 | ICD10CM | Covered |
| G71.21 | ICD10CM | Covered |
| G71.220 | ICD10CM | Covered |
| G71.228 | ICD10CM | Covered |
| G71.29 | ICD10CM | Covered |
| G71.3 | ICD10CM | Covered |
| G71.8 | ICD10CM | Covered |
| G71.9 | ICD10CM | Covered |
| G72.0 | ICD10CM | Covered |
| G72.1 | ICD10CM | Covered |
| G72.2 | ICD10CM | Covered |
| G72.3 | ICD10CM | Covered |
| G72.41 | ICD10CM | Covered |
| G72.49 | ICD10CM | Covered |
| G72.81 | ICD10CM | Covered |
| G72.89 | ICD10CM | Covered |
| G72.9 | ICD10CM | Covered |
| G73.1 | ICD10CM | Covered |
| G73.3 | ICD10CM | Covered |
| G73.7 | ICD10CM | Covered |
| G80.0 | ICD10CM | Covered |
| G80.1 | ICD10CM | Covered |
| G80.2 | ICD10CM | Covered |
| G80.8 | ICD10CM | Covered |
| G81.11 | ICD10CM | Covered |
| G81.12 | ICD10CM | Covered |
| G81.13 | ICD10CM | Covered |
| G81.14 | ICD10CM | Covered |
| G82.20 | ICD10CM | Covered |
| G82.21 | ICD10CM | Covered |
| G82.22 | ICD10CM | Covered |
| G82.50 | ICD10CM | Covered |
| G82.51 | ICD10CM | Covered |
| G82.52 | ICD10CM | Covered |
| G82.53 | ICD10CM | Covered |
| G82.54 | ICD10CM | Covered |
| G83.0 | ICD10CM | Covered |
| G83.10 | ICD10CM | Covered |
| G83.11 | ICD10CM | Covered |
| G83.12 | ICD10CM | Covered |
| G83.13 | ICD10CM | Covered |
| G83.14 | ICD10CM | Covered |
| G83.20 | ICD10CM | Covered |
| G83.21 | ICD10CM | Covered |
| G83.22 | ICD10CM | Covered |
| G83.23 | ICD10CM | Covered |
| G83.24 | ICD10CM | Covered |
| G83.30 | ICD10CM | Covered |
| G83.31 | ICD10CM | Covered |
| G83.32 | ICD10CM | Covered |
| G83.33 | ICD10CM | Covered |
| G83.34 | ICD10CM | Covered |
| G83.4 | ICD10CM | Covered |
| G83.5 | ICD10CM | Covered |
| G83.81 | ICD10CM | Covered |
| G83.82 | ICD10CM | Covered |
| G83.83 | ICD10CM | Covered |
| G83.89 | ICD10CM | Covered |
| G95.0 | ICD10CM | Covered |
| G95.11 | ICD10CM | Covered |
| G95.19 | ICD10CM | Covered |
| G95.20 | ICD10CM | Covered |
| G95.29 | ICD10CM | Covered |
| G95.81 | ICD10CM | Covered |
| G95.89 | ICD10CM | Covered |
| G99.2 | ICD10CM | Covered |
| H02.401 | ICD10CM | Covered |
| H02.402 | ICD10CM | Covered |
| H02.403 | ICD10CM | Covered |
| H02.421 | ICD10CM | Covered |
| H02.422 | ICD10CM | Covered |
| H02.423 | ICD10CM | Covered |
| H05.821 | ICD10CM | Covered |
| H05.822 | ICD10CM | Covered |
| H05.823 | ICD10CM | Covered |
| H49.01 | ICD10CM | Covered |
| H49.02 | ICD10CM | Covered |
| H49.03 | ICD10CM | Covered |
| H49.11 | ICD10CM | Covered |
| H49.12 | ICD10CM | Covered |
| H49.13 | ICD10CM | Covered |
| H49.21 | ICD10CM | Covered |
| H49.22 | ICD10CM | Covered |
| H49.23 | ICD10CM | Covered |
| H49.31 | ICD10CM | Covered |
| H49.32 | ICD10CM | Covered |
| H49.33 | ICD10CM | Covered |
| H49.41 | ICD10CM | Covered |
| H49.42 | ICD10CM | Covered |
| H49.43 | ICD10CM | Covered |
| H49.881 | ICD10CM | Covered |
| H49.882 | ICD10CM | Covered |
| H49.883 | ICD10CM | Covered |
| H50.011 | ICD10CM | Covered |
| H50.012 | ICD10CM | Covered |
| H50.021 | ICD10CM | Covered |
| H50.022 | ICD10CM | Covered |
| H50.031 | ICD10CM | Covered |
| H50.032 | ICD10CM | Covered |
| H50.041 | ICD10CM | Covered |
| H50.042 | ICD10CM | Covered |
| H50.05 | ICD10CM | Covered |
| H50.06 | ICD10CM | Covered |
| H50.07 | ICD10CM | Covered |
| H50.08 | ICD10CM | Covered |
| H50.111 | ICD10CM | Covered |
| H50.112 | ICD10CM | Covered |
| H50.121 | ICD10CM | Covered |
| H50.122 | ICD10CM | Covered |
| H50.131 | ICD10CM | Covered |
| H50.132 | ICD10CM | Covered |
| H50.141 | ICD10CM | Covered |
| H50.142 | ICD10CM | Covered |
| H50.15 | ICD10CM | Covered |
| H50.16 | ICD10CM | Covered |
| H50.17 | ICD10CM | Covered |
| H50.18 | ICD10CM | Covered |
| H50.21 | ICD10CM | Covered |
| H50.22 | ICD10CM | Covered |
| H50.311 | ICD10CM | Covered |
| H50.312 | ICD10CM | Covered |
| H50.32 | ICD10CM | Covered |
| H50.331 | ICD10CM | Covered |
| H50.332 | ICD10CM | Covered |
| H50.34 | ICD10CM | Covered |
| H50.411 | ICD10CM | Covered |
| H50.412 | ICD10CM | Covered |
| H50.42 | ICD10CM | Covered |
| H50.43 | ICD10CM | Covered |
| H50.51 | ICD10CM | Covered |
| H50.52 | ICD10CM | Covered |
| H50.53 | ICD10CM | Covered |
| H50.54 | ICD10CM | Covered |
| H50.55 | ICD10CM | Covered |
| H50.611 | ICD10CM | Covered |
| H50.612 | ICD10CM | Covered |
| H50.69 | ICD10CM | Covered |
| H50.811 | ICD10CM | Covered |
| H50.812 | ICD10CM | Covered |
| H50.89 | ICD10CM | Covered |
| H51.11 | ICD10CM | Covered |
| H51.8 | ICD10CM | Covered |
| H53.2 | ICD10CM | Covered |
| H53.8 | ICD10CM | Covered |
| I69.031 | ICD10CM | Covered |
| I69.032 | ICD10CM | Covered |
| I69.033 | ICD10CM | Covered |
| I69.034 | ICD10CM | Covered |
| I69.041 | ICD10CM | Covered |
| I69.042 | ICD10CM | Covered |
| I69.043 | ICD10CM | Covered |
| I69.044 | ICD10CM | Covered |
| I69.051 | ICD10CM | Covered |
| I69.052 | ICD10CM | Covered |
| I69.053 | ICD10CM | Covered |
| I69.054 | ICD10CM | Covered |
| I69.061 | ICD10CM | Covered |
| I69.062 | ICD10CM | Covered |
| I69.063 | ICD10CM | Covered |
| I69.064 | ICD10CM | Covered |
| I69.065 | ICD10CM | Covered |
| I69.131 | ICD10CM | Covered |
| I69.132 | ICD10CM | Covered |
| I69.133 | ICD10CM | Covered |
| I69.134 | ICD10CM | Covered |
| I69.141 | ICD10CM | Covered |
| I69.142 | ICD10CM | Covered |
| I69.143 | ICD10CM | Covered |
| I69.144 | ICD10CM | Covered |
| I69.151 | ICD10CM | Covered |
| I69.152 | ICD10CM | Covered |
| I69.153 | ICD10CM | Covered |
| I69.154 | ICD10CM | Covered |
| I69.161 | ICD10CM | Covered |
| I69.162 | ICD10CM | Covered |
| I69.163 | ICD10CM | Covered |
| I69.164 | ICD10CM | Covered |
| I69.165 | ICD10CM | Covered |
| I69.231 | ICD10CM | Covered |
| I69.232 | ICD10CM | Covered |
| I69.233 | ICD10CM | Covered |
| I69.234 | ICD10CM | Covered |
| I69.241 | ICD10CM | Covered |
| I69.242 | ICD10CM | Covered |
| I69.243 | ICD10CM | Covered |
| I69.244 | ICD10CM | Covered |
| I69.251 | ICD10CM | Covered |
| I69.252 | ICD10CM | Covered |
| I69.253 | ICD10CM | Covered |
| I69.254 | ICD10CM | Covered |
| I69.261 | ICD10CM | Covered |
| I69.262 | ICD10CM | Covered |
| I69.263 | ICD10CM | Covered |
| I69.264 | ICD10CM | Covered |
| I69.265 | ICD10CM | Covered |
| I69.331 | ICD10CM | Covered |
| I69.332 | ICD10CM | Covered |
| I69.333 | ICD10CM | Covered |
| I69.334 | ICD10CM | Covered |
| I69.341 | ICD10CM | Covered |
| I69.342 | ICD10CM | Covered |
| I69.343 | ICD10CM | Covered |
| I69.344 | ICD10CM | Covered |
| I69.351 | ICD10CM | Covered |
| I69.352 | ICD10CM | Covered |
| I69.353 | ICD10CM | Covered |
| I69.354 | ICD10CM | Covered |
| I69.361 | ICD10CM | Covered |
| I69.362 | ICD10CM | Covered |
| I69.363 | ICD10CM | Covered |
| I69.364 | ICD10CM | Covered |
| I69.365 | ICD10CM | Covered |
| I69.831 | ICD10CM | Covered |
| I69.832 | ICD10CM | Covered |
| I69.833 | ICD10CM | Covered |
| I69.834 | ICD10CM | Covered |
| I69.841 | ICD10CM | Covered |
| I69.842 | ICD10CM | Covered |
| I69.843 | ICD10CM | Covered |
| I69.844 | ICD10CM | Covered |
| I69.851 | ICD10CM | Covered |
| I69.852 | ICD10CM | Covered |
| I69.853 | ICD10CM | Covered |
| I69.854 | ICD10CM | Covered |
| I69.931 | ICD10CM | Covered |
| I69.932 | ICD10CM | Covered |
| I69.933 | ICD10CM | Covered |
| I69.934 | ICD10CM | Covered |
| I69.941 | ICD10CM | Covered |
| I69.942 | ICD10CM | Covered |
| I69.943 | ICD10CM | Covered |
| I69.944 | ICD10CM | Covered |
| I69.951 | ICD10CM | Covered |
| I69.952 | ICD10CM | Covered |
| I69.953 | ICD10CM | Covered |
| I69.954 | ICD10CM | Covered |
| J38.01 | ICD10CM | Covered |
| J38.02 | ICD10CM | Covered |
| J38.5 | ICD10CM | Covered |
| K11.7 | ICD10CM | Covered |
| K22.0 | ICD10CM | Covered |
| K59.01 | ICD10CM | Covered |
| K59.02 | ICD10CM | Covered |
| K59.04 | ICD10CM | Covered |
| K59.09 | ICD10CM | Covered |
| K59.2 | ICD10CM | Covered |
| K59.4 | ICD10CM | Covered |
| K60.1 | ICD10CM | Covered |
| L74.510 | ICD10CM | Covered |
| M05.411 | ICD10CM | Covered |
| M05.412 | ICD10CM | Covered |
| M05.421 | ICD10CM | Covered |
| M05.422 | ICD10CM | Covered |
| M05.431 | ICD10CM | Covered |
| M05.432 | ICD10CM | Covered |
| M05.441 | ICD10CM | Covered |
| M05.442 | ICD10CM | Covered |
| M05.451 | ICD10CM | Covered |
| M05.452 | ICD10CM | Covered |
| M05.461 | ICD10CM | Covered |
| M05.462 | ICD10CM | Covered |
| M05.471 | ICD10CM | Covered |
| M05.472 | ICD10CM | Covered |
| M05.49 | ICD10CM | Covered |
| M05.511 | ICD10CM | Covered |
| M05.512 | ICD10CM | Covered |
| M05.521 | ICD10CM | Covered |
| M05.522 | ICD10CM | Covered |
| M05.531 | ICD10CM | Covered |
| M05.532 | ICD10CM | Covered |
| M05.541 | ICD10CM | Covered |
| M05.542 | ICD10CM | Covered |
| M05.551 | ICD10CM | Covered |
| M05.552 | ICD10CM | Covered |
| M05.561 | ICD10CM | Covered |
| M05.562 | ICD10CM | Covered |
| M05.571 | ICD10CM | Covered |
| M05.572 | ICD10CM | Covered |
| M05.59 | ICD10CM | Covered |
| M21.331 | ICD10CM | Covered |
| M21.332 | ICD10CM | Covered |
| M21.371 | ICD10CM | Covered |
| M21.372 | ICD10CM | Covered |
| M33.02 | ICD10CM | Covered |
| M33.12 | ICD10CM | Covered |
| M33.22 | ICD10CM | Covered |
| M33.92 | ICD10CM | Covered |
| M34.82 | ICD10CM | Covered |
| M35.03 | ICD10CM | Covered |
| M36.0 | ICD10CM | Covered |
| M43.3 | ICD10CM | Covered |
| M47.11 | ICD10CM | Covered |
| M47.12 | ICD10CM | Covered |
| M47.13 | ICD10CM | Covered |
| M47.14 | ICD10CM | Covered |
| M47.15 | ICD10CM | Covered |
| M47.16 | ICD10CM | Covered |
| M47.21 | ICD10CM | Covered |
| M47.22 | ICD10CM | Covered |
| M47.23 | ICD10CM | Covered |
| M47.24 | ICD10CM | Covered |
| M47.25 | ICD10CM | Covered |
| M47.26 | ICD10CM | Covered |
| M47.27 | ICD10CM | Covered |
| M47.28 | ICD10CM | Covered |
| M48.01 | ICD10CM | Covered |
| M48.02 | ICD10CM | Covered |
| M48.03 | ICD10CM | Covered |
| M48.04 | ICD10CM | Covered |
| M48.05 | ICD10CM | Covered |
| M48.061 | ICD10CM | Covered |
| M48.062 | ICD10CM | Covered |
| M48.07 | ICD10CM | Covered |
| M48.08 | ICD10CM | Covered |
| M50.01 | ICD10CM | Covered |
| M50.021 | ICD10CM | Covered |
| M50.022 | ICD10CM | Covered |
| M50.023 | ICD10CM | Covered |
| M50.03 | ICD10CM | Covered |
| M50.11 | ICD10CM | Covered |
| M50.121 | ICD10CM | Covered |
| M50.122 | ICD10CM | Covered |
| M50.123 | ICD10CM | Covered |
| M50.13 | ICD10CM | Covered |
| M51.04 | ICD10CM | Covered |
| M51.05 | ICD10CM | Covered |
| M51.06 | ICD10CM | Covered |
| M51.14 | ICD10CM | Covered |
| M51.15 | ICD10CM | Covered |
| M51.16 | ICD10CM | Covered |
| M51.17 | ICD10CM | Covered |
| M53.0 | ICD10CM | Covered |
| M53.1 | ICD10CM | Covered |
| M53.82 | ICD10CM | Covered |
| M54.11 | ICD10CM | Covered |
| M54.12 | ICD10CM | Covered |
| M54.13 | ICD10CM | Covered |
| M54.14 | ICD10CM | Covered |
| M54.15 | ICD10CM | Covered |
| M54.16 | ICD10CM | Covered |
| M54.17 | ICD10CM | Covered |
| M54.18 | ICD10CM | Covered |
| M54.31 | ICD10CM | Covered |
| M54.32 | ICD10CM | Covered |
| M54.41 | ICD10CM | Covered |
| M54.42 | ICD10CM | Covered |
| M54.81 | ICD10CM | Covered |
| M60.011 | ICD10CM | Covered |
| M60.012 | ICD10CM | Covered |
| M60.021 | ICD10CM | Covered |
| M60.022 | ICD10CM | Covered |
| M60.031 | ICD10CM | Covered |
| M60.032 | ICD10CM | Covered |
| M60.041 | ICD10CM | Covered |
| M60.042 | ICD10CM | Covered |
| M60.044 | ICD10CM | Covered |
| M60.045 | ICD10CM | Covered |
| M60.051 | ICD10CM | Covered |
| M60.052 | ICD10CM | Covered |
| M60.061 | ICD10CM | Covered |
| M60.062 | ICD10CM | Covered |
| M60.070 | ICD10CM | Covered |
| M60.071 | ICD10CM | Covered |
| M60.073 | ICD10CM | Covered |
| M60.074 | ICD10CM | Covered |
| M60.076 | ICD10CM | Covered |
| M60.077 | ICD10CM | Covered |
| M60.08 | ICD10CM | Covered |
| M60.09 | ICD10CM | Covered |
| M60.111 | ICD10CM | Covered |
| M60.112 | ICD10CM | Covered |
| M60.121 | ICD10CM | Covered |
| M60.122 | ICD10CM | Covered |
| M60.131 | ICD10CM | Covered |
| M60.132 | ICD10CM | Covered |
| M60.141 | ICD10CM | Covered |
| M60.142 | ICD10CM | Covered |
| M60.151 | ICD10CM | Covered |
| M60.152 | ICD10CM | Covered |
| M60.161 | ICD10CM | Covered |
| M60.162 | ICD10CM | Covered |
| M60.171 | ICD10CM | Covered |
| M60.172 | ICD10CM | Covered |
| M60.18 | ICD10CM | Covered |
| M60.19 | ICD10CM | Covered |
| M60.811 | ICD10CM | Covered |
| M60.812 | ICD10CM | Covered |
| M60.821 | ICD10CM | Covered |
| M60.822 | ICD10CM | Covered |
| M60.831 | ICD10CM | Covered |
| M60.832 | ICD10CM | Covered |
| M60.841 | ICD10CM | Covered |
| M60.842 | ICD10CM | Covered |
| M60.851 | ICD10CM | Covered |
| M60.852 | ICD10CM | Covered |
| M60.861 | ICD10CM | Covered |
| M60.862 | ICD10CM | Covered |
| M60.871 | ICD10CM | Covered |
| M60.872 | ICD10CM | Covered |
| M60.88 | ICD10CM | Covered |
| M60.89 | ICD10CM | Covered |
| M62.511 | ICD10CM | Covered |
| M62.512 | ICD10CM | Covered |
| M62.521 | ICD10CM | Covered |
| M62.522 | ICD10CM | Covered |
| M62.531 | ICD10CM | Covered |
| M62.532 | ICD10CM | Covered |
| M62.541 | ICD10CM | Covered |
| M62.542 | ICD10CM | Covered |
| M62.551 | ICD10CM | Covered |
| M62.552 | ICD10CM | Covered |
| M62.561 | ICD10CM | Covered |
| M62.562 | ICD10CM | Covered |
| M62.571 | ICD10CM | Covered |
| M62.572 | ICD10CM | Covered |
| M62.58 | ICD10CM | Covered |
| M62.59 | ICD10CM | Covered |
| M62.5A0 | ICD10CM | Covered |
| M62.5A1 | ICD10CM | Covered |
| M62.5A2 | ICD10CM | Covered |
| M62.81 | ICD10CM | Covered |
| M62.82 | ICD10CM | Covered |
| M62.830 | ICD10CM | Covered |
| M62.831 | ICD10CM | Covered |
| M62.838 | ICD10CM | Covered |
| M62.85 | ICD10CM | Covered |
| M63.811 | ICD10CM | Covered |
| M63.812 | ICD10CM | Covered |
| M63.821 | ICD10CM | Covered |
| M63.822 | ICD10CM | Covered |
| M63.831 | ICD10CM | Covered |
| M63.832 | ICD10CM | Covered |
| M63.841 | ICD10CM | Covered |
| M63.842 | ICD10CM | Covered |
| M63.851 | ICD10CM | Covered |
| M63.852 | ICD10CM | Covered |
| M63.861 | ICD10CM | Covered |
| M63.862 | ICD10CM | Covered |
| M63.871 | ICD10CM | Covered |
| M63.872 | ICD10CM | Covered |
| M63.88 | ICD10CM | Covered |
| M63.89 | ICD10CM | Covered |
| M79.11 | ICD10CM | Covered |
| M79.12 | ICD10CM | Covered |
| M79.18 | ICD10CM | Covered |
| M79.621 | ICD10CM | Covered |
| M79.622 | ICD10CM | Covered |
| M79.631 | ICD10CM | Covered |
| M79.632 | ICD10CM | Covered |
| M79.641 | ICD10CM | Covered |
| M79.642 | ICD10CM | Covered |
| M79.644 | ICD10CM | Covered |
| M79.645 | ICD10CM | Covered |
| M79.651 | ICD10CM | Covered |
| M79.652 | ICD10CM | Covered |
| M79.661 | ICD10CM | Covered |
| M79.662 | ICD10CM | Covered |
| M79.671 | ICD10CM | Covered |
| M79.672 | ICD10CM | Covered |
| M79.674 | ICD10CM | Covered |
| M79.675 | ICD10CM | Covered |
| M99.20 | ICD10CM | Covered |
| M99.21 | ICD10CM | Covered |
| M99.22 | ICD10CM | Covered |
| M99.23 | ICD10CM | Covered |
| M99.24 | ICD10CM | Covered |
| M99.25 | ICD10CM | Covered |
| M99.26 | ICD10CM | Covered |
| M99.27 | ICD10CM | Covered |
| M99.28 | ICD10CM | Covered |
| M99.29 | ICD10CM | Covered |
| M99.30 | ICD10CM | Covered |
| M99.31 | ICD10CM | Covered |
| M99.32 | ICD10CM | Covered |
| M99.33 | ICD10CM | Covered |
| M99.34 | ICD10CM | Covered |
| M99.35 | ICD10CM | Covered |
| M99.36 | ICD10CM | Covered |
| M99.37 | ICD10CM | Covered |
| M99.38 | ICD10CM | Covered |
| M99.39 | ICD10CM | Covered |
| M99.40 | ICD10CM | Covered |
| M99.41 | ICD10CM | Covered |
| M99.42 | ICD10CM | Covered |
| M99.43 | ICD10CM | Covered |
| M99.44 | ICD10CM | Covered |
| M99.45 | ICD10CM | Covered |
| M99.46 | ICD10CM | Covered |
| M99.47 | ICD10CM | Covered |
| M99.48 | ICD10CM | Covered |
| M99.49 | ICD10CM | Covered |
| M99.50 | ICD10CM | Covered |
| M99.51 | ICD10CM | Covered |
| M99.52 | ICD10CM | Covered |
| M99.53 | ICD10CM | Covered |
| M99.54 | ICD10CM | Covered |
| M99.55 | ICD10CM | Covered |
| M99.56 | ICD10CM | Covered |
| M99.57 | ICD10CM | Covered |
| M99.58 | ICD10CM | Covered |
| M99.59 | ICD10CM | Covered |
| M99.60 | ICD10CM | Covered |
| M99.61 | ICD10CM | Covered |
| M99.62 | ICD10CM | Covered |
| M99.63 | ICD10CM | Covered |
| M99.64 | ICD10CM | Covered |
| M99.65 | ICD10CM | Covered |
| M99.66 | ICD10CM | Covered |
| M99.67 | ICD10CM | Covered |
| M99.68 | ICD10CM | Covered |
| M99.69 | ICD10CM | Covered |
| M99.70 | ICD10CM | Covered |
| M99.71 | ICD10CM | Covered |
| M99.72 | ICD10CM | Covered |
| M99.73 | ICD10CM | Covered |
| M99.74 | ICD10CM | Covered |
| M99.75 | ICD10CM | Covered |
| M99.76 | ICD10CM | Covered |
| M99.77 | ICD10CM | Covered |
| M99.78 | ICD10CM | Covered |
| M99.79 | ICD10CM | Covered |
| N31.0 | ICD10CM | Covered |
| N31.1 | ICD10CM | Covered |
| N31.2 | ICD10CM | Covered |
| N31.8 | ICD10CM | Covered |
| N31.9 | ICD10CM | Covered |
| N32.81 | ICD10CM | Covered |
| N36.42 | ICD10CM | Covered |
| N36.43 | ICD10CM | Covered |
| N36.44 | ICD10CM | Covered |
| N36.8 | ICD10CM | Covered |
| N39.3 | ICD10CM | Covered |
| N39.41 | ICD10CM | Covered |
| N39.42 | ICD10CM | Covered |
| N39.43 | ICD10CM | Covered |
| N39.44 | ICD10CM | Covered |
| N39.45 | ICD10CM | Covered |
| N39.46 | ICD10CM | Covered |
| N39.490 | ICD10CM | Covered |
| N39.491 | ICD10CM | Covered |
| N39.492 | ICD10CM | Covered |
| N39.498 | ICD10CM | Covered |
| Q05.0 | ICD10CM | Covered |
| Q05.1 | ICD10CM | Covered |
| Q05.2 | ICD10CM | Covered |
| Q05.3 | ICD10CM | Covered |
| Q05.5 | ICD10CM | Covered |
| Q05.6 | ICD10CM | Covered |
| Q05.7 | ICD10CM | Covered |
| Q05.8 | ICD10CM | Covered |
| Q06.1 | ICD10CM | Covered |
| Q06.2 | ICD10CM | Covered |
| Q06.3 | ICD10CM | Covered |
| Q06.4 | ICD10CM | Covered |
| Q06.8 | ICD10CM | Covered |
| Q07.00 | ICD10CM | Covered |
| Q07.01 | ICD10CM | Covered |
| Q07.02 | ICD10CM | Covered |
| Q07.03 | ICD10CM | Covered |
| R06.02 | ICD10CM | Covered |
| R13.11 | ICD10CM | Covered |
| R13.12 | ICD10CM | Covered |
| R13.13 | ICD10CM | Covered |
| R13.14 | ICD10CM | Covered |
| R13.19 | ICD10CM | Covered |
| R15.0 | ICD10CM | Covered |
| R15.1 | ICD10CM | Covered |
| R15.2 | ICD10CM | Covered |
| R15.9 | ICD10CM | Covered |
| R20.0 | ICD10CM | Covered |
| R20.1 | ICD10CM | Covered |
| R20.2 | ICD10CM | Covered |
| R20.3 | ICD10CM | Covered |
| R20.8 | ICD10CM | Covered |
| R25.0 | ICD10CM | Covered |
| R25.1 | ICD10CM | Covered |
| R25.2 | ICD10CM | Covered |
| R25.3 | ICD10CM | Covered |
| R26.0 | ICD10CM | Covered |
| R26.1 | ICD10CM | Covered |
| R26.81 | ICD10CM | Covered |
| R26.89 | ICD10CM | Covered |
| R27.8 | ICD10CM | Covered |
| R29.2 | ICD10CM | Covered |
| R29.5 | ICD10CM | Covered |
| R29.6 | ICD10CM | Covered |
| R29.810 | ICD10CM | Covered |
| R29.818 | ICD10CM | Covered |
| R32 | ICD10CM | Covered |
| R33.8 | ICD10CM | Covered |
| R33.9 | ICD10CM | Covered |
| R35.0 | ICD10CM | Covered |
| R39.14 | ICD10CM | Covered |
| R39.15 | ICD10CM | Covered |
| R39.191 | ICD10CM | Covered |
| R43.0 | ICD10CM | Covered |
| R43.1 | ICD10CM | Covered |
| R43.2 | ICD10CM | Covered |
| R43.8 | ICD10CM | Covered |
| R47.02 | ICD10CM | Covered |
| R47.1 | ICD10CM | Covered |
| R47.81 | ICD10CM | Covered |
| R47.82 | ICD10CM | Covered |
| R47.89 | ICD10CM | Covered |
| R49.0 | ICD10CM | Covered |
| R49.8 | ICD10CM | Covered |
| R53.83 | ICD10CM | Covered |
| R63.39 | ICD10CM | Covered |
| S04.011A | ICD10CM | Covered |
| S04.011D | ICD10CM | Covered |
| S04.011S | ICD10CM | Covered |
| S04.012A | ICD10CM | Covered |
| S04.012D | ICD10CM | Covered |
| S04.012S | ICD10CM | Covered |
| S04.11XA | ICD10CM | Covered |
| S04.11XD | ICD10CM | Covered |
| S04.11XS | ICD10CM | Covered |
| S04.12XA | ICD10CM | Covered |
| S04.12XD | ICD10CM | Covered |
| S04.12XS | ICD10CM | Covered |
| S04.21XA | ICD10CM | Covered |
| S04.21XD | ICD10CM | Covered |
| S04.21XS | ICD10CM | Covered |
| S04.22XA | ICD10CM | Covered |
| S04.22XD | ICD10CM | Covered |
| S04.22XS | ICD10CM | Covered |
| S04.31XA | ICD10CM | Covered |
| S04.31XD | ICD10CM | Covered |
| S04.31XS | ICD10CM | Covered |
| S04.32XA | ICD10CM | Covered |
| S04.32XD | ICD10CM | Covered |
| S04.32XS | ICD10CM | Covered |
| S04.41XA | ICD10CM | Covered |
| S04.41XD | ICD10CM | Covered |
| S04.41XS | ICD10CM | Covered |
| S04.42XA | ICD10CM | Covered |
| S04.42XD | ICD10CM | Covered |
| S04.42XS | ICD10CM | Covered |
| S04.51XA | ICD10CM | Covered |
| S04.51XD | ICD10CM | Covered |
| S04.51XS | ICD10CM | Covered |
| S04.52XA | ICD10CM | Covered |
| S04.52XD | ICD10CM | Covered |
| S04.52XS | ICD10CM | Covered |
| S04.61XA | ICD10CM | Covered |
| S04.61XD | ICD10CM | Covered |
| S04.61XS | ICD10CM | Covered |
| S04.62XA | ICD10CM | Covered |
| S04.62XD | ICD10CM | Covered |
| S04.62XS | ICD10CM | Covered |
| S04.71XA | ICD10CM | Covered |
| S04.71XD | ICD10CM | Covered |
| S04.71XS | ICD10CM | Covered |
| S04.72XA | ICD10CM | Covered |
| S04.72XD | ICD10CM | Covered |
| S04.72XS | ICD10CM | Covered |
| S04.811A | ICD10CM | Covered |
| S04.811D | ICD10CM | Covered |
| S04.811S | ICD10CM | Covered |
| S04.812A | ICD10CM | Covered |
| S04.812D | ICD10CM | Covered |
| S04.812S | ICD10CM | Covered |
| S04.891A | ICD10CM | Covered |
| S04.891D | ICD10CM | Covered |
| S04.891S | ICD10CM | Covered |
| S04.892A | ICD10CM | Covered |
| S04.892D | ICD10CM | Covered |
| S04.892S | ICD10CM | Covered |
| S14.0XXA | ICD10CM | Covered |
| S14.0XXD | ICD10CM | Covered |
| S14.0XXS | ICD10CM | Covered |
| S14.111A | ICD10CM | Covered |
| S14.111D | ICD10CM | Covered |
| S14.111S | ICD10CM | Covered |
| S14.112A | ICD10CM | Covered |
| S14.112D | ICD10CM | Covered |
| S14.112S | ICD10CM | Covered |
| S14.113A | ICD10CM | Covered |
| S14.113D | ICD10CM | Covered |
| S14.113S | ICD10CM | Covered |
| S14.114A | ICD10CM | Covered |
| S14.114D | ICD10CM | Covered |
| S14.114S | ICD10CM | Covered |
| S14.115A | ICD10CM | Covered |
| S14.115D | ICD10CM | Covered |
| S14.115S | ICD10CM | Covered |
| S14.116A | ICD10CM | Covered |
| S14.116D | ICD10CM | Covered |
| S14.116S | ICD10CM | Covered |
| S14.117A | ICD10CM | Covered |
| S14.117D | ICD10CM | Covered |
| S14.117S | ICD10CM | Covered |
| S14.118A | ICD10CM | Covered |
| S14.118D | ICD10CM | Covered |
| S14.118S | ICD10CM | Covered |
| S14.121A | ICD10CM | Covered |
| S14.121D | ICD10CM | Covered |
| S14.121S | ICD10CM | Covered |
| S14.122A | ICD10CM | Covered |
| S14.122D | ICD10CM | Covered |
| S14.122S | ICD10CM | Covered |
| S14.123A | ICD10CM | Covered |
| S14.123D | ICD10CM | Covered |
| S14.123S | ICD10CM | Covered |
| S14.124A | ICD10CM | Covered |
| S14.124D | ICD10CM | Covered |
| S14.124S | ICD10CM | Covered |
| S14.125A | ICD10CM | Covered |
| S14.125D | ICD10CM | Covered |
| S14.125S | ICD10CM | Covered |
| S14.126A | ICD10CM | Covered |
| S14.126D | ICD10CM | Covered |
| S14.126S | ICD10CM | Covered |
| S14.127A | ICD10CM | Covered |
| S14.127D | ICD10CM | Covered |
| S14.127S | ICD10CM | Covered |
| S14.128A | ICD10CM | Covered |
| S14.128D | ICD10CM | Covered |
| S14.128S | ICD10CM | Covered |