Policy source
The recorded policy does not contain a public text excerpt. Read the official source for details.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
Showing the first 1,000 of 2,751 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 93000 | HCPCS | Covered |
| 93005 | HCPCS | Covered |
| 93010 | HCPCS | Covered |
| 93040 | HCPCS | Covered |
| 93041 | HCPCS | Covered |
| 93042 | HCPCS | Covered |
| A01.01 | ICD10CM | Covered |
| A01.02 | ICD10CM | Covered |
| A01.03 | ICD10CM | Covered |
| A01.04 | ICD10CM | Covered |
| A01.05 | ICD10CM | Covered |
| A01.09 | ICD10CM | Covered |
| A02.1 | ICD10CM | Covered |
| A05.1 | ICD10CM | Covered |
| A17.83 | ICD10CM | Covered |
| A17.89 | ICD10CM | Covered |
| A18.82 | ICD10CM | Covered |
| A18.84 | ICD10CM | Covered |
| A18.89 | ICD10CM | Covered |
| A19.0 | ICD10CM | Covered |
| A19.1 | ICD10CM | Covered |
| A19.8 | ICD10CM | Covered |
| A20.7 | ICD10CM | Covered |
| A22.7 | ICD10CM | Covered |
| A26.7 | ICD10CM | Covered |
| A32.7 | ICD10CM | Covered |
| A36.81 | ICD10CM | Covered |
| A39.2 | ICD10CM | Covered |
| A39.3 | ICD10CM | Covered |
| A39.50 | ICD10CM | Covered |
| A39.51 | ICD10CM | Covered |
| A39.52 | ICD10CM | Covered |
| A39.53 | ICD10CM | Covered |
| A40.0 | ICD10CM | Covered |
| A40.1 | ICD10CM | Covered |
| A40.3 | ICD10CM | Covered |
| A40.8 | ICD10CM | Covered |
| A41.01 | ICD10CM | Covered |
| A41.02 | ICD10CM | Covered |
| A41.1 | ICD10CM | Covered |
| A41.3 | ICD10CM | Covered |
| A41.4 | ICD10CM | Covered |
| A41.51 | ICD10CM | Covered |
| A41.52 | ICD10CM | Covered |
| A41.53 | ICD10CM | Covered |
| A41.54 | ICD10CM | Covered |
| A41.59 | ICD10CM | Covered |
| A41.81 | ICD10CM | Covered |
| A41.89 | ICD10CM | Covered |
| A42.7 | ICD10CM | Covered |
| A48.0 | ICD10CM | Covered |
| A52.01 | ICD10CM | Covered |
| A52.03 | ICD10CM | Covered |
| A52.04 | ICD10CM | Covered |
| A52.05 | ICD10CM | Covered |
| A52.06 | ICD10CM | Covered |
| A52.09 | ICD10CM | Covered |
| A54.83 | ICD10CM | Covered |
| A54.86 | ICD10CM | Covered |
| B00.7 | ICD10CM | Covered |
| B20 | ICD10CM | Covered |
| B33.0 | ICD10CM | Covered |
| B33.20 | ICD10CM | Covered |
| B33.21 | ICD10CM | Covered |
| B33.22 | ICD10CM | Covered |
| B33.23 | ICD10CM | Covered |
| B33.24 | ICD10CM | Covered |
| B37.6 | ICD10CM | Covered |
| B37.7 | ICD10CM | Covered |
| B39.0 | ICD10CM | Covered |
| B39.1 | ICD10CM | Covered |
| B39.2 | ICD10CM | Covered |
| B39.3 | ICD10CM | Covered |
| B39.4 | ICD10CM | Covered |
| B39.5 | ICD10CM | Covered |
| B57.0 | ICD10CM | Covered |
| B57.2 | ICD10CM | Covered |
| B58.81 | ICD10CM | Covered |
| B58.89 | ICD10CM | Covered |
| B75 | ICD10CM | Covered |
| C37 | ICD10CM | Covered |
| C38.0 | ICD10CM | Covered |
| C38.1 | ICD10CM | Covered |
| C38.2 | ICD10CM | Covered |
| C38.4 | ICD10CM | Covered |
| C38.8 | ICD10CM | Covered |
| C45.0 | ICD10CM | Covered |
| C45.2 | ICD10CM | Covered |
| D15.0 | ICD10CM | Covered |
| D15.1 | ICD10CM | Covered |
| D15.2 | ICD10CM | Covered |
| D19.0 | ICD10CM | Covered |
| D56.8 | 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 |
| D57.40 | ICD10CM | Covered |
| D57.411 | ICD10CM | Covered |
| D57.412 | ICD10CM | Covered |
| D57.413 | ICD10CM | Covered |
| D57.414 | ICD10CM | Covered |
| D57.418 | ICD10CM | Covered |
| D57.42 | ICD10CM | Covered |
| D57.431 | ICD10CM | Covered |
| D57.432 | ICD10CM | Covered |
| D57.433 | ICD10CM | Covered |
| D57.434 | ICD10CM | Covered |
| D57.438 | ICD10CM | Covered |
| D57.439 | ICD10CM | Covered |
| D57.44 | ICD10CM | Covered |
| D57.451 | ICD10CM | Covered |
| D57.452 | ICD10CM | Covered |
| D57.453 | ICD10CM | Covered |
| D57.454 | ICD10CM | Covered |
| D57.458 | ICD10CM | Covered |
| D57.459 | ICD10CM | Covered |
| D57.80 | ICD10CM | Covered |
| D57.811 | ICD10CM | Covered |
| D57.812 | ICD10CM | Covered |
| D57.813 | ICD10CM | Covered |
| D57.814 | ICD10CM | Covered |
| D57.818 | ICD10CM | Covered |
| D57.819 | ICD10CM | Covered |
| D86.0 | ICD10CM | Covered |
| D86.1 | ICD10CM | Covered |
| D86.2 | ICD10CM | Covered |
| D86.3 | ICD10CM | Covered |
| D86.81 | ICD10CM | Covered |
| D86.82 | ICD10CM | Covered |
| D86.83 | ICD10CM | Covered |
| D86.84 | ICD10CM | Covered |
| D86.85 | ICD10CM | Covered |
| D86.86 | ICD10CM | Covered |
| D86.87 | ICD10CM | Covered |
| D86.89 | ICD10CM | Covered |
| E00.0 | ICD10CM | Covered |
| E00.1 | ICD10CM | Covered |
| E00.2 | ICD10CM | Covered |
| E01.8 | ICD10CM | Covered |
| E02 | ICD10CM | Covered |
| E03.0 | ICD10CM | Covered |
| E03.1 | ICD10CM | Covered |
| E03.2 | ICD10CM | Covered |
| E03.3 | ICD10CM | Covered |
| E03.5 | ICD10CM | Covered |
| E03.8 | ICD10CM | Covered |
| E05.00 | ICD10CM | Covered |
| E05.01 | ICD10CM | Covered |
| E05.10 | ICD10CM | Covered |
| E05.11 | ICD10CM | Covered |
| E05.20 | ICD10CM | Covered |
| E05.21 | ICD10CM | Covered |
| E05.30 | ICD10CM | Covered |
| E05.31 | ICD10CM | Covered |
| E05.40 | ICD10CM | Covered |
| E05.41 | ICD10CM | Covered |
| E05.80 | ICD10CM | Covered |
| E05.81 | ICD10CM | Covered |
| E05.91 | ICD10CM | Covered |
| E08.51 | ICD10CM | Covered |
| E08.52 | ICD10CM | Covered |
| E09.51 | ICD10CM | Covered |
| E09.52 | ICD10CM | Covered |
| E10.51 | ICD10CM | Covered |
| E10.52 | ICD10CM | Covered |
| E11.51 | ICD10CM | Covered |
| E11.52 | ICD10CM | Covered |
| E13.51 | ICD10CM | Covered |
| E13.52 | ICD10CM | Covered |
| E20.0 | ICD10CM | Covered |
| E20.1 | ICD10CM | Covered |
| E21.0 | ICD10CM | Covered |
| E21.1 | ICD10CM | Covered |
| E21.2 | ICD10CM | Covered |
| E21.4 | ICD10CM | Covered |
| E24.0 | ICD10CM | Covered |
| E24.2 | ICD10CM | Covered |
| E24.3 | ICD10CM | Covered |
| E24.4 | ICD10CM | Covered |
| E24.8 | ICD10CM | Covered |
| E25.0 | ICD10CM | Covered |
| E25.8 | ICD10CM | Covered |
| E26.01 | ICD10CM | Covered |
| E26.02 | ICD10CM | Covered |
| E26.09 | ICD10CM | Covered |
| E26.1 | ICD10CM | Covered |
| E26.81 | ICD10CM | Covered |
| E26.89 | ICD10CM | Covered |
| E27.0 | ICD10CM | Covered |
| E27.1 | ICD10CM | Covered |
| E27.2 | ICD10CM | Covered |
| E27.3 | ICD10CM | Covered |
| E27.49 | ICD10CM | Covered |
| E27.5 | ICD10CM | Covered |
| E27.8 | ICD10CM | Covered |
| E35 | ICD10CM | Covered |
| E51.11 | ICD10CM | Covered |
| E51.12 | ICD10CM | Covered |
| E51.2 | ICD10CM | Covered |
| E51.8 | ICD10CM | Covered |
| E52 | ICD10CM | Covered |
| E75.21 | ICD10CM | Covered |
| E75.22 | ICD10CM | Covered |
| E75.240 | ICD10CM | Covered |
| E75.241 | ICD10CM | Covered |
| E75.242 | ICD10CM | Covered |
| E75.243 | ICD10CM | Covered |
| E75.244 | ICD10CM | Covered |
| E75.248 | ICD10CM | Covered |
| E75.27 | ICD10CM | Covered |
| E75.28 | ICD10CM | Covered |
| E75.5 | ICD10CM | Covered |
| E77.0 | ICD10CM | Covered |
| E77.1 | ICD10CM | Covered |
| E77.8 | ICD10CM | Covered |
| E78.00 | ICD10CM | Covered |
| E78.010 | ICD10CM | Covered |
| E78.011 | ICD10CM | Covered |
| E78.019 | ICD10CM | Covered |
| E78.1 | ICD10CM | Covered |
| E78.2 | ICD10CM | Covered |
| E78.3 | ICD10CM | Covered |
| E78.41 | ICD10CM | Covered |
| E78.49 | ICD10CM | Covered |
| E78.6 | ICD10CM | Covered |
| E78.79 | ICD10CM | Covered |
| E78.81 | ICD10CM | Covered |
| E78.89 | ICD10CM | Covered |
| E83.31 | ICD10CM | Covered |
| E83.32 | ICD10CM | Covered |
| E83.39 | ICD10CM | Covered |
| E83.41 | ICD10CM | Covered |
| E83.42 | ICD10CM | Covered |
| E83.49 | ICD10CM | Covered |
| E83.51 | ICD10CM | Covered |
| E83.52 | ICD10CM | Covered |
| E83.59 | ICD10CM | Covered |
| E83.81 | ICD10CM | Covered |
| E85.0 | ICD10CM | Covered |
| E85.1 | ICD10CM | Covered |
| E85.2 | ICD10CM | Covered |
| E85.3 | ICD10CM | Covered |
| E85.4 | ICD10CM | Covered |
| E85.81 | ICD10CM | Covered |
| E85.82 | ICD10CM | Covered |
| E85.89 | ICD10CM | Covered |
| E85.9 | ICD10CM | Covered |
| E86.0 | ICD10CM | Covered |
| E86.1 | ICD10CM | Covered |
| E87.0 | ICD10CM | Covered |
| E87.1 | ICD10CM | Covered |
| E87.20 | ICD10CM | Covered |
| E87.21 | ICD10CM | Covered |
| E87.22 | ICD10CM | Covered |
| E87.29 | ICD10CM | Covered |
| E87.3 | ICD10CM | Covered |
| E87.4 | ICD10CM | Covered |
| E87.5 | ICD10CM | Covered |
| E87.6 | ICD10CM | Covered |
| E87.71 | ICD10CM | Covered |
| E87.79 | ICD10CM | Covered |
| E87.8 | ICD10CM | Covered |
| E88.10 | ICD10CM | Covered |
| E88.11 | ICD10CM | Covered |
| E88.12 | ICD10CM | Covered |
| E88.13 | ICD10CM | Covered |
| E88.14 | ICD10CM | Covered |
| E88.19 | ICD10CM | Covered |
| E88.2 | ICD10CM | Covered |
| E88.810 | ICD10CM | Covered |
| E88.811 | ICD10CM | Covered |
| E88.818 | ICD10CM | Covered |
| E88.819 | ICD10CM | Covered |
| E88.89 | ICD10CM | Covered |
| E89.0 | ICD10CM | Covered |
| E89.2 | ICD10CM | Covered |
| E89.6 | ICD10CM | Covered |
| F11.10 | ICD10CM | Covered |
| F11.120 | ICD10CM | Covered |
| F11.129 | ICD10CM | Covered |
| F11.13 | ICD10CM | Covered |
| F14.10 | ICD10CM | Covered |
| F14.120 | ICD10CM | Covered |
| F14.13 | ICD10CM | Covered |
| F15.10 | ICD10CM | Covered |
| F15.120 | ICD10CM | Covered |
| F15.13 | ICD10CM | Covered |
| F45.8 | ICD10CM | Covered |
| F51.8 | ICD10CM | Covered |
| G45.3 | ICD10CM | Covered |
| G47.11 | ICD10CM | Covered |
| G47.12 | ICD10CM | Covered |
| G47.21 | ICD10CM | Covered |
| G47.22 | ICD10CM | Covered |
| G47.23 | ICD10CM | Covered |
| G47.24 | ICD10CM | Covered |
| G47.31 | ICD10CM | Covered |
| G47.32 | ICD10CM | Covered |
| G47.33 | ICD10CM | Covered |
| G47.34 | ICD10CM | Covered |
| G47.8 | ICD10CM | Covered |
| G62.0 | ICD10CM | Covered |
| G90.01 | ICD10CM | Covered |
| G90.09 | ICD10CM | Covered |
| G93.31 | ICD10CM | Covered |
| G93.32 | ICD10CM | Covered |
| G93.39 | 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 |
| H34.8120 | ICD10CM | Covered |
| H34.8121 | ICD10CM | Covered |
| H34.8130 | ICD10CM | Covered |
| H34.8131 | ICD10CM | Covered |
| H34.821 | ICD10CM | Covered |
| H34.822 | ICD10CM | Covered |
| H34.823 | ICD10CM | Covered |
| H34.8310 | ICD10CM | Covered |
| H34.8311 | ICD10CM | Covered |
| H34.8320 | ICD10CM | Covered |
| H34.8321 | ICD10CM | Covered |
| H34.8330 | ICD10CM | Covered |
| H34.8331 | ICD10CM | Covered |
| I00 | ICD10CM | Covered |
| I01.0 | ICD10CM | Covered |
| I01.1 | ICD10CM | Covered |
| I01.2 | ICD10CM | Covered |
| I01.8 | ICD10CM | Covered |
| I01.9 | ICD10CM | Covered |
| I02.0 | ICD10CM | Covered |
| I02.9 | ICD10CM | Covered |
| I05.0 | ICD10CM | Covered |
| I05.1 | ICD10CM | Covered |
| I05.2 | ICD10CM | Covered |
| I05.8 | ICD10CM | Covered |
| I05.9 | ICD10CM | Covered |
| I06.0 | ICD10CM | Covered |
| I06.1 | ICD10CM | Covered |
| I06.2 | ICD10CM | Covered |
| I06.8 | ICD10CM | Covered |
| I06.9 | ICD10CM | Covered |
| I07.0 | ICD10CM | Covered |
| I07.1 | ICD10CM | Covered |
| I07.2 | ICD10CM | Covered |
| I07.8 | ICD10CM | Covered |
| I08.0 | ICD10CM | Covered |
| I08.1 | ICD10CM | Covered |
| I08.2 | ICD10CM | Covered |
| I08.3 | ICD10CM | Covered |
| I08.8 | ICD10CM | Covered |
| I08.9 | ICD10CM | Covered |
| I09.0 | ICD10CM | Covered |
| I09.1 | ICD10CM | Covered |
| I09.2 | ICD10CM | Covered |
| I09.81 | ICD10CM | Covered |
| I09.89 | ICD10CM | Covered |
| I10 | ICD10CM | Covered |
| I11.0 | ICD10CM | Covered |
| I11.9 | ICD10CM | Covered |
| I12.0 | ICD10CM | Covered |
| I12.9 | ICD10CM | Covered |
| I13.0 | ICD10CM | Covered |
| I13.10 | ICD10CM | Covered |
| I13.11 | ICD10CM | Covered |
| I13.2 | ICD10CM | Covered |
| I15.0 | ICD10CM | Covered |
| I15.1 | ICD10CM | Covered |
| I15.2 | ICD10CM | Covered |
| I15.8 | ICD10CM | Covered |
| I20.0 | ICD10CM | Covered |
| I20.1 | ICD10CM | Covered |
| I20.9 | ICD10CM | Covered |
| I21.01 | ICD10CM | Covered |
| I21.02 | ICD10CM | Covered |
| I21.09 | ICD10CM | Covered |
| I21.11 | ICD10CM | Covered |
| I21.19 | ICD10CM | Covered |
| I21.21 | ICD10CM | Covered |
| I21.29 | ICD10CM | Covered |
| I21.4 | ICD10CM | Covered |
| I21.9 | ICD10CM | Covered |
| I21.A1 | ICD10CM | Covered |
| I21.A9 | ICD10CM | Covered |
| I22.0 | ICD10CM | Covered |
| I22.1 | ICD10CM | Covered |
| I22.2 | ICD10CM | Covered |
| I22.8 | ICD10CM | Covered |
| I23.0 | ICD10CM | Covered |
| I23.1 | ICD10CM | Covered |
| I23.2 | ICD10CM | Covered |
| I23.3 | ICD10CM | Covered |
| I23.4 | ICD10CM | Covered |
| I23.5 | ICD10CM | Covered |
| I23.6 | ICD10CM | Covered |
| I23.7 | ICD10CM | Covered |
| I23.8 | ICD10CM | Covered |
| I24.0 | ICD10CM | Covered |
| I24.1 | ICD10CM | Covered |
| I24.9 | ICD10CM | Covered |
| I25.10 | ICD10CM | Covered |
| I25.110 | ICD10CM | Covered |
| I25.111 | ICD10CM | Covered |
| I25.112 | ICD10CM | Covered |
| I25.118 | ICD10CM | Covered |
| I25.119 | ICD10CM | Covered |
| I25.2 | ICD10CM | Covered |
| I25.3 | ICD10CM | Covered |
| I25.41 | ICD10CM | Covered |
| I25.42 | ICD10CM | Covered |
| I25.5 | ICD10CM | Covered |
| I25.6 | ICD10CM | Covered |
| I25.701 | ICD10CM | Covered |
| I25.702 | ICD10CM | Covered |
| I25.708 | ICD10CM | Covered |
| I25.709 | ICD10CM | Covered |
| I25.710 | ICD10CM | Covered |
| I25.711 | ICD10CM | Covered |
| I25.712 | ICD10CM | Covered |
| I25.718 | ICD10CM | Covered |
| I25.719 | ICD10CM | Covered |
| I25.720 | ICD10CM | Covered |
| I25.721 | ICD10CM | Covered |
| I25.722 | ICD10CM | Covered |
| I25.728 | ICD10CM | Covered |
| I25.729 | ICD10CM | Covered |
| I25.730 | ICD10CM | Covered |
| I25.731 | ICD10CM | Covered |
| I25.732 | ICD10CM | Covered |
| I25.738 | ICD10CM | Covered |
| I25.739 | ICD10CM | Covered |
| I25.750 | ICD10CM | Covered |
| I25.751 | ICD10CM | Covered |
| I25.752 | ICD10CM | Covered |
| I25.758 | ICD10CM | Covered |
| I25.759 | ICD10CM | Covered |
| I25.760 | ICD10CM | Covered |
| I25.761 | ICD10CM | Covered |
| I25.762 | ICD10CM | Covered |
| I25.768 | ICD10CM | Covered |
| I25.769 | ICD10CM | Covered |
| I25.790 | ICD10CM | Covered |
| I25.791 | ICD10CM | Covered |
| I25.792 | ICD10CM | Covered |
| I25.798 | ICD10CM | Covered |
| I25.799 | ICD10CM | Covered |
| I25.810 | ICD10CM | Covered |
| I25.811 | ICD10CM | Covered |
| I25.812 | ICD10CM | Covered |
| I25.83 | ICD10CM | Covered |
| I25.84 | ICD10CM | Covered |
| I25.85 | ICD10CM | Covered |
| I25.89 | ICD10CM | Covered |
| I26.01 | ICD10CM | Covered |
| I26.02 | ICD10CM | Covered |
| I26.03 | ICD10CM | Covered |
| I26.04 | ICD10CM | Covered |
| I26.09 | ICD10CM | Covered |
| I26.92 | ICD10CM | Covered |
| I26.93 | ICD10CM | Covered |
| I26.94 | ICD10CM | Covered |
| I26.95 | ICD10CM | Covered |
| I26.96 | ICD10CM | Covered |
| I26.99 | ICD10CM | Covered |
| I27.0 | ICD10CM | Covered |
| I27.1 | ICD10CM | Covered |
| I27.20 | ICD10CM | Covered |
| I27.21 | ICD10CM | Covered |
| I27.22 | ICD10CM | Covered |
| I27.23 | ICD10CM | Covered |
| I27.24 | ICD10CM | Covered |
| I27.29 | ICD10CM | Covered |
| I27.81 | ICD10CM | Covered |
| I27.83 | ICD10CM | Covered |
| I27.840 | ICD10CM | Covered |
| I27.841 | ICD10CM | Covered |
| I27.848 | ICD10CM | Covered |
| I27.849 | ICD10CM | Covered |
| I27.89 | ICD10CM | Covered |
| I28.0 | ICD10CM | Covered |
| I28.1 | ICD10CM | Covered |
| I28.8 | ICD10CM | Covered |
| I30.0 | ICD10CM | Covered |
| I30.1 | ICD10CM | Covered |
| I30.8 | ICD10CM | Covered |
| I30.9 | ICD10CM | Covered |
| I31.0 | ICD10CM | Covered |
| I31.1 | ICD10CM | Covered |
| I31.2 | ICD10CM | Covered |
| I31.31 | ICD10CM | Covered |
| I31.39 | ICD10CM | Covered |
| I31.8 | ICD10CM | Covered |
| I32 | ICD10CM | Covered |
| I33.0 | ICD10CM | Covered |
| I33.9 | ICD10CM | Covered |
| I34.0 | ICD10CM | Covered |
| I34.1 | ICD10CM | Covered |
| I34.2 | ICD10CM | Covered |
| I34.81 | ICD10CM | Covered |
| I34.89 | ICD10CM | Covered |
| I35.0 | ICD10CM | Covered |
| I35.1 | ICD10CM | Covered |
| I35.2 | ICD10CM | Covered |
| I35.8 | ICD10CM | Covered |
| I36.0 | ICD10CM | Covered |
| I36.1 | ICD10CM | Covered |
| I36.2 | ICD10CM | Covered |
| I36.8 | ICD10CM | Covered |
| I37.0 | ICD10CM | Covered |
| I37.1 | ICD10CM | Covered |
| I37.2 | ICD10CM | Covered |
| I37.8 | ICD10CM | Covered |
| I39 | ICD10CM | Covered |
| I40.0 | ICD10CM | Covered |
| I40.1 | ICD10CM | Covered |
| I40.8 | ICD10CM | Covered |
| I40.9 | ICD10CM | Covered |
| I41 | ICD10CM | Covered |
| I42.00 | ICD10CM | Covered |
| I42.01 | ICD10CM | Covered |
| I42.09 | ICD10CM | Covered |
| I42.1 | ICD10CM | Covered |
| I42.2 | ICD10CM | Covered |
| I42.3 | ICD10CM | Covered |
| I42.4 | ICD10CM | Covered |
| I42.5 | ICD10CM | Covered |
| I42.6 | ICD10CM | Covered |
| I42.7 | ICD10CM | Covered |
| I42.81 | ICD10CM | Covered |
| I42.89 | ICD10CM | Covered |
| I43 | ICD10CM | Covered |
| I44.0 | ICD10CM | Covered |
| I44.1 | ICD10CM | Covered |
| I44.2 | ICD10CM | Covered |
| I44.30 | ICD10CM | Covered |
| I44.39 | ICD10CM | Covered |
| I44.4 | ICD10CM | Covered |
| I44.5 | ICD10CM | Covered |
| I44.69 | ICD10CM | Covered |
| I44.7 | ICD10CM | Covered |
| I45.0 | ICD10CM | Covered |
| I45.19 | ICD10CM | Covered |
| I45.2 | ICD10CM | Covered |
| I45.3 | ICD10CM | Covered |
| I45.4 | ICD10CM | Covered |
| I45.5 | ICD10CM | Covered |
| I45.6 | ICD10CM | Covered |
| I45.81 | ICD10CM | Covered |
| I45.89 | ICD10CM | Covered |
| I45.9 | ICD10CM | Covered |
| I46.2 | ICD10CM | Covered |
| I46.8 | ICD10CM | Covered |
| I47.0 | ICD10CM | Covered |
| I47.10 | ICD10CM | Covered |
| I47.11 | ICD10CM | Covered |
| I47.19 | ICD10CM | Covered |
| I47.20 | ICD10CM | Covered |
| I47.21 | ICD10CM | Covered |
| I47.22 | ICD10CM | Covered |
| I47.29 | ICD10CM | Covered |
| I47.9 | ICD10CM | Covered |
| I48.0 | ICD10CM | Covered |
| I48.11 | ICD10CM | Covered |
| I48.19 | ICD10CM | Covered |
| I48.20 | ICD10CM | Covered |
| I48.21 | ICD10CM | Covered |
| I48.3 | ICD10CM | Covered |
| I48.4 | ICD10CM | Covered |
| I48.91 | ICD10CM | Covered |
| I48.92 | ICD10CM | Covered |
| I49.01 | ICD10CM | Covered |
| I49.02 | ICD10CM | Covered |
| I49.1 | ICD10CM | Covered |
| I49.2 | ICD10CM | Covered |
| I49.3 | ICD10CM | Covered |
| I49.40 | ICD10CM | Covered |
| I49.49 | ICD10CM | Covered |
| I49.5 | ICD10CM | Covered |
| I49.81 | ICD10CM | Covered |
| I49.82 | ICD10CM | Covered |
| I49.89 | ICD10CM | Covered |
| I49.9 | ICD10CM | Covered |
| I50.1 | ICD10CM | Covered |
| I50.21 | ICD10CM | Covered |
| I50.22 | ICD10CM | Covered |
| I50.23 | ICD10CM | Covered |
| I50.31 | ICD10CM | Covered |
| I50.32 | ICD10CM | Covered |
| I50.33 | ICD10CM | Covered |
| I50.41 | ICD10CM | Covered |
| I50.42 | ICD10CM | Covered |
| I50.43 | ICD10CM | Covered |
| I50.810 | ICD10CM | Covered |
| I50.811 | ICD10CM | Covered |
| I50.812 | ICD10CM | Covered |
| I50.813 | ICD10CM | Covered |
| I50.814 | ICD10CM | Covered |
| I50.82 | ICD10CM | Covered |
| I50.83 | ICD10CM | Covered |
| I50.84 | ICD10CM | Covered |
| I50.89 | ICD10CM | Covered |
| I51.0 | ICD10CM | Covered |
| I51.1 | ICD10CM | Covered |
| I51.2 | ICD10CM | Covered |
| I51.3 | ICD10CM | Covered |
| I51.5 | ICD10CM | Covered |
| I51.7 | ICD10CM | Covered |
| I51.89 | ICD10CM | Covered |
| I52 | ICD10CM | Covered |
| I63.033 | ICD10CM | Covered |
| I63.113 | ICD10CM | Covered |
| I63.133 | ICD10CM | Covered |
| I63.213 | ICD10CM | Covered |
| I63.233 | ICD10CM | Covered |
| I63.313 | ICD10CM | Covered |
| I63.323 | ICD10CM | Covered |
| I63.333 | ICD10CM | Covered |
| I63.411 | ICD10CM | Covered |
| I63.412 | ICD10CM | Covered |
| I63.413 | ICD10CM | Covered |
| I63.421 | ICD10CM | Covered |
| I63.422 | ICD10CM | Covered |
| I63.423 | ICD10CM | Covered |
| I63.431 | ICD10CM | Covered |
| I63.432 | ICD10CM | Covered |
| I63.433 | ICD10CM | Covered |
| I63.441 | ICD10CM | Covered |
| I63.442 | ICD10CM | Covered |
| I63.443 | ICD10CM | Covered |
| I63.49 | ICD10CM | Covered |
| I63.511 | ICD10CM | Covered |
| I63.512 | ICD10CM | Covered |
| I63.513 | ICD10CM | Covered |
| I63.521 | ICD10CM | Covered |
| I63.522 | ICD10CM | Covered |
| I63.523 | ICD10CM | Covered |
| I63.531 | ICD10CM | Covered |
| I63.532 | ICD10CM | Covered |
| I63.533 | ICD10CM | Covered |
| I63.541 | ICD10CM | Covered |
| I63.542 | ICD10CM | Covered |
| I63.543 | ICD10CM | Covered |
| I63.59 | ICD10CM | Covered |
| I63.81 | ICD10CM | Covered |
| I63.89 | ICD10CM | Covered |
| I63.9 | ICD10CM | Covered |
| I66.01 | ICD10CM | Covered |
| I66.02 | ICD10CM | Covered |
| I66.03 | ICD10CM | Covered |
| I66.11 | ICD10CM | Covered |
| I66.12 | ICD10CM | Covered |
| I66.13 | ICD10CM | Covered |
| I66.21 | ICD10CM | Covered |
| I66.22 | ICD10CM | Covered |
| I66.23 | ICD10CM | Covered |
| I66.3 | ICD10CM | Covered |
| I66.8 | ICD10CM | Covered |
| I67.0 | ICD10CM | Covered |
| I67.841 | ICD10CM | Covered |
| I67.848 | ICD10CM | Covered |
| I67.850 | ICD10CM | Covered |
| I67.858 | ICD10CM | Covered |
| I67.89 | ICD10CM | Covered |
| I70.0 | ICD10CM | Covered |
| I70.461 | ICD10CM | Covered |
| I70.462 | ICD10CM | Covered |
| I70.463 | ICD10CM | Covered |
| I70.468 | ICD10CM | Covered |
| I70.561 | ICD10CM | Covered |
| I70.562 | ICD10CM | Covered |
| I70.563 | ICD10CM | Covered |
| I70.568 | ICD10CM | Covered |
| I70.661 | ICD10CM | Covered |
| I70.662 | ICD10CM | Covered |
| I70.663 | ICD10CM | Covered |
| I70.668 | ICD10CM | Covered |
| I70.761 | ICD10CM | Covered |
| I70.762 | ICD10CM | Covered |
| I70.763 | ICD10CM | Covered |
| I70.768 | ICD10CM | Covered |
| I70.91 | ICD10CM | Covered |
| I71.010 | ICD10CM | Covered |
| I71.011 | ICD10CM | Covered |
| I71.012 | ICD10CM | Covered |
| I71.019 | ICD10CM | Covered |
| I71.02 | ICD10CM | Covered |
| I71.03 | ICD10CM | Covered |
| I71.10 | ICD10CM | Covered |
| I71.11 | ICD10CM | Covered |
| I71.12 | ICD10CM | Covered |
| I71.13 | ICD10CM | Covered |
| I71.20 | ICD10CM | Covered |
| I71.21 | ICD10CM | Covered |
| I71.22 | ICD10CM | Covered |
| I71.23 | ICD10CM | Covered |
| I71.30 | ICD10CM | Covered |
| I71.31 | ICD10CM | Covered |
| I71.32 | ICD10CM | Covered |
| I71.33 | ICD10CM | Covered |
| I71.40 | ICD10CM | Covered |
| I71.41 | ICD10CM | Covered |
| I71.42 | ICD10CM | Covered |
| I71.43 | ICD10CM | Covered |
| I71.50 | ICD10CM | Covered |
| I71.51 | ICD10CM | Covered |
| I71.52 | ICD10CM | Covered |
| I71.60 | ICD10CM | Covered |
| I71.61 | ICD10CM | Covered |
| I71.62 | ICD10CM | Covered |
| I72.8 | ICD10CM | Covered |
| I73.00 | ICD10CM | Covered |
| I73.01 | ICD10CM | Covered |
| I73.1 | ICD10CM | Covered |
| I73.89 | ICD10CM | Covered |
| I74.11 | ICD10CM | Covered |
| I74.2 | ICD10CM | Covered |
| I74.3 | ICD10CM | Covered |
| I74.5 | ICD10CM | Covered |
| I74.8 | ICD10CM | Covered |
| I75.011 | ICD10CM | Covered |
| I75.012 | ICD10CM | Covered |
| I75.013 | ICD10CM | Covered |
| I75.021 | ICD10CM | Covered |
| I75.022 | ICD10CM | Covered |
| I75.023 | ICD10CM | Covered |
| I75.81 | ICD10CM | Covered |
| I75.89 | ICD10CM | Covered |
| I77.71 | ICD10CM | Covered |
| I77.72 | ICD10CM | Covered |
| I77.73 | ICD10CM | Covered |
| I77.74 | ICD10CM | Covered |
| I77.79 | ICD10CM | Covered |
| I77.810 | ICD10CM | Covered |
| I77.82 | ICD10CM | Covered |
| I79.0 | ICD10CM | Covered |
| I79.1 | ICD10CM | Covered |
| I79.8 | ICD10CM | Covered |
| I87.1 | ICD10CM | Covered |
| I95.0 | ICD10CM | Covered |
| I95.1 | ICD10CM | Covered |
| I95.2 | ICD10CM | Covered |
| I95.3 | ICD10CM | Covered |
| I95.81 | ICD10CM | Covered |
| I95.89 | ICD10CM | Covered |
| I96 | ICD10CM | Covered |
| I97.0 | ICD10CM | Covered |
| I97.110 | ICD10CM | Covered |
| I97.111 | ICD10CM | Covered |
| I97.120 | ICD10CM | Covered |
| I97.121 | ICD10CM | Covered |
| I97.130 | ICD10CM | Covered |
| I97.131 | ICD10CM | Covered |
| I97.190 | ICD10CM | Covered |
| I97.191 | ICD10CM | Covered |
| I97.621 | ICD10CM | Covered |
| I97.622 | ICD10CM | Covered |
| I97.630 | ICD10CM | Covered |
| I97.631 | ICD10CM | Covered |
| I97.638 | ICD10CM | Covered |
| I97.640 | ICD10CM | Covered |
| I97.641 | ICD10CM | Covered |
| I97.710 | ICD10CM | Covered |
| I97.711 | ICD10CM | Covered |
| I97.790 | ICD10CM | Covered |
| I97.791 | ICD10CM | Covered |
| I97.88 | ICD10CM | Covered |
| I97.89 | ICD10CM | Covered |
| J43.0 | ICD10CM | Covered |
| J43.1 | ICD10CM | Covered |
| J43.2 | ICD10CM | Covered |
| J43.8 | ICD10CM | Covered |
| J44.0 | ICD10CM | Covered |
| J44.1 | ICD10CM | Covered |
| J44.9 | ICD10CM | Covered |
| J45.20 | ICD10CM | Covered |
| J45.21 | ICD10CM | Covered |
| J45.22 | ICD10CM | Covered |
| J45.30 | ICD10CM | Covered |
| J45.31 | ICD10CM | Covered |
| J45.32 | ICD10CM | Covered |
| J45.40 | ICD10CM | Covered |
| J45.41 | ICD10CM | Covered |
| J45.42 | ICD10CM | Covered |
| J45.50 | ICD10CM | Covered |
| J45.51 | ICD10CM | Covered |
| J45.52 | ICD10CM | Covered |
| J45.902 | ICD10CM | Covered |
| J45.990 | ICD10CM | Covered |
| J45.991 | ICD10CM | Covered |
| J45.998 | ICD10CM | Covered |
| J68.1 | ICD10CM | Covered |
| J80 | ICD10CM | Covered |
| J81.0 | ICD10CM | Covered |
| J86.9 | ICD10CM | Covered |
| J90 | ICD10CM | Covered |
| J91.0 | ICD10CM | Covered |
| J91.8 | ICD10CM | Covered |
| J92.0 | ICD10CM | Covered |
| J92.9 | ICD10CM | Covered |
| J94.0 | ICD10CM | Covered |
| J94.1 | ICD10CM | Covered |
| J94.2 | ICD10CM | Covered |
| J94.8 | ICD10CM | Covered |
| J95.1 | ICD10CM | Covered |
| J95.2 | ICD10CM | Covered |
| J95.3 | ICD10CM | Covered |
| J95.821 | ICD10CM | Covered |
| J95.822 | ICD10CM | Covered |
| J95.87 | ICD10CM | Covered |
| J96.01 | ICD10CM | Covered |
| J96.02 | ICD10CM | Covered |
| J96.11 | ICD10CM | Covered |
| J96.12 | ICD10CM | Covered |
| J96.21 | ICD10CM | Covered |
| J96.22 | ICD10CM | Covered |
| J98.3 | ICD10CM | Covered |
| J98.51 | ICD10CM | Covered |
| J98.59 | ICD10CM | Covered |
| K21.9 | ICD10CM | Covered |
| K22.0 | ICD10CM | Covered |
| K22.10 | ICD10CM | Covered |
| K22.11 | ICD10CM | Covered |
| K22.2 | ICD10CM | Covered |
| K22.3 | ICD10CM | Covered |
| K22.4 | ICD10CM | Covered |
| K22.70 | ICD10CM | Covered |
| K22.710 | ICD10CM | Covered |
| K22.711 | ICD10CM | Covered |
| K44.0 | ICD10CM | Covered |
| K81.0 | ICD10CM | Covered |
| K81.1 | ICD10CM | Covered |
| K81.2 | ICD10CM | Covered |
| K82.A2 | ICD10CM | Covered |
| K83.01 | ICD10CM | Covered |
| M05.111 | ICD10CM | Covered |
| M05.112 | ICD10CM | Covered |
| M05.121 | ICD10CM | Covered |
| M05.122 | ICD10CM | Covered |
| M05.131 | ICD10CM | Covered |
| M05.132 | ICD10CM | Covered |
| M05.141 | ICD10CM | Covered |
| M05.142 | ICD10CM | Covered |
| M05.151 | ICD10CM | Covered |
| M05.152 | ICD10CM | Covered |
| M05.161 | ICD10CM | Covered |
| M05.162 | ICD10CM | Covered |
| M05.171 | ICD10CM | Covered |
| M05.172 | ICD10CM | Covered |
| M05.19 | ICD10CM | Covered |
| M05.211 | ICD10CM | Covered |
| M05.212 | ICD10CM | Covered |
| M05.221 | ICD10CM | Covered |
| M05.222 | ICD10CM | Covered |
| M05.231 | ICD10CM | Covered |
| M05.232 | ICD10CM | Covered |
| M05.241 | ICD10CM | Covered |
| M05.242 | ICD10CM | Covered |
| M05.251 | ICD10CM | Covered |
| M05.252 | ICD10CM | Covered |
| M05.261 | ICD10CM | Covered |
| M05.262 | ICD10CM | Covered |
| M05.271 | ICD10CM | Covered |
| M05.272 | ICD10CM | Covered |
| M05.29 | ICD10CM | Covered |
| M05.311 | ICD10CM | Covered |
| M05.312 | ICD10CM | Covered |
| M05.321 | ICD10CM | Covered |
| M05.322 | ICD10CM | Covered |
| M05.331 | ICD10CM | Covered |
| M05.332 | ICD10CM | Covered |
| M05.341 | ICD10CM | Covered |
| M05.342 | ICD10CM | Covered |
| M05.351 | ICD10CM | Covered |
| M05.352 | ICD10CM | Covered |
| M05.361 | ICD10CM | Covered |
| M05.362 | ICD10CM | Covered |
| M05.371 | ICD10CM | Covered |
| M05.372 | ICD10CM | Covered |
| M05.39 | ICD10CM | Covered |
| M05.611 | ICD10CM | Covered |
| M05.612 | ICD10CM | Covered |
| M05.621 | ICD10CM | Covered |
| M05.622 | ICD10CM | Covered |
| M05.631 | ICD10CM | Covered |
| M05.632 | ICD10CM | Covered |
| M05.641 | ICD10CM | Covered |
| M05.642 | ICD10CM | Covered |
| M05.651 | ICD10CM | Covered |
| M05.652 | ICD10CM | Covered |
| M05.661 | ICD10CM | Covered |
| M05.662 | ICD10CM | Covered |
| M05.671 | ICD10CM | Covered |
| M05.672 | ICD10CM | Covered |
| M05.69 | ICD10CM | Covered |
| M06.1 | ICD10CM | Covered |
| M10.9 | ICD10CM | Covered |
| M30.0 | ICD10CM | Covered |
| M30.2 | ICD10CM | Covered |
| M30.8 | ICD10CM | Covered |
| M31.0 | ICD10CM | Covered |
| M31.4 | ICD10CM | Covered |
| M31.7 | ICD10CM | Covered |
| M32.0 | ICD10CM | Covered |
| M32.11 | ICD10CM | Covered |
| M32.12 | ICD10CM | Covered |
| M32.13 | ICD10CM | Covered |
| M32.14 | ICD10CM | Covered |
| M32.15 | ICD10CM | Covered |
| M32.19 | ICD10CM | Covered |
| M32.8 | ICD10CM | Covered |
| M54.2 | ICD10CM | Covered |
| M54.6 | ICD10CM | Covered |
| M79.601 | ICD10CM | Covered |
| M79.602 | ICD10CM | Covered |
| M79.604 | ICD10CM | Covered |
| M79.605 | ICD10CM | Covered |
| M79.621 | ICD10CM | Covered |
| M79.622 | ICD10CM | Covered |
| M79.631 | ICD10CM | Covered |
| M79.632 | ICD10CM | Covered |
| M79.641 | ICD10CM | Covered |
| M79.642 | ICD10CM | Covered |
| M79.644 | ICD10CM | Covered |
| M79.645 | ICD10CM | Covered |
| M79.651 | ICD10CM | Covered |
| M79.652 | ICD10CM | Covered |
| M79.661 | ICD10CM | Covered |
| M79.662 | ICD10CM | Covered |
| M79.671 | ICD10CM | Covered |
| M79.672 | ICD10CM | Covered |
| M79.674 | ICD10CM | Covered |
| M79.675 | ICD10CM | Covered |
| M94.0 | ICD10CM | Covered |
| M95.4 | ICD10CM | Covered |
| M99.82 | ICD10CM | Covered |
| M99.88 | ICD10CM | Covered |
| N26.2 | ICD10CM | Covered |
| N64.4 | ICD10CM | Covered |
| O03.2 | ICD10CM | Covered |
| O03.31 | ICD10CM | Covered |
| O03.7 | ICD10CM | Covered |
| O03.81 | ICD10CM | Covered |
| O04.7 | ICD10CM | Covered |
| O04.81 | ICD10CM | Covered |
| O07.2 | ICD10CM | Covered |
| O07.31 | ICD10CM | Covered |
| O08.2 | ICD10CM | Covered |
| O08.3 | ICD10CM | Covered |
| O08.7 | ICD10CM | Covered |
| O08.81 | ICD10CM | Covered |
| O08.83 | ICD10CM | Covered |
| O08.89 | ICD10CM | Covered |
| O10.011 | ICD10CM | Covered |
| O10.012 | ICD10CM | Covered |
| O10.013 | ICD10CM | Covered |
| O10.02 | ICD10CM | Covered |
| O10.03 | ICD10CM | Covered |
| O10.111 | ICD10CM | Covered |
| O10.112 | ICD10CM | Covered |
| O10.113 | ICD10CM | Covered |
| O10.12 | ICD10CM | Covered |
| O10.13 | ICD10CM | Covered |
| O10.211 | ICD10CM | Covered |
| O10.212 | ICD10CM | Covered |
| O10.213 | ICD10CM | Covered |
| O10.22 | ICD10CM | Covered |
| O10.23 | ICD10CM | Covered |
| O10.311 | ICD10CM | Covered |
| O10.312 | ICD10CM | Covered |
| O10.313 | ICD10CM | Covered |
| O10.32 | ICD10CM | Covered |
| O10.33 | ICD10CM | Covered |
| O10.411 | ICD10CM | Covered |
| O10.412 | ICD10CM | Covered |
| O10.413 | ICD10CM | Covered |
| O10.42 | ICD10CM | Covered |
| O10.43 | ICD10CM | Covered |
| O11.1 | ICD10CM | Covered |
| O11.2 | ICD10CM | Covered |
| O11.3 | ICD10CM | Covered |
| O13.1 | ICD10CM | Covered |