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 2,053 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 00100 | HCPCS | Covered |
| 00124 | HCPCS | Covered |
| 00148 | HCPCS | Covered |
| 00160 | HCPCS | Covered |
| 00164 | HCPCS | Covered |
| 00300 | HCPCS | Covered |
| 00322 | HCPCS | Covered |
| 00400 | HCPCS | Covered |
| 00410 | HCPCS | Covered |
| 00454 | HCPCS | Covered |
| 00520 | HCPCS | Covered |
| 00522 | HCPCS | Covered |
| 00524 | HCPCS | Covered |
| 00530 | HCPCS | Covered |
| 00532 | HCPCS | Covered |
| 00635 | HCPCS | Covered |
| 00640 | HCPCS | Covered |
| 00702 | HCPCS | Covered |
| 00731 | HCPCS | Covered |
| 00732 | HCPCS | Covered |
| 00842 | HCPCS | Covered |
| 00920 | HCPCS | Covered |
| 00921 | HCPCS | Covered |
| 01130 | HCPCS | Covered |
| 01380 | HCPCS | Covered |
| 01420 | HCPCS | Covered |
| 01490 | HCPCS | Covered |
| 01680 | HCPCS | Covered |
| 01730 | HCPCS | Covered |
| 01780 | HCPCS | Covered |
| 01782 | HCPCS | Covered |
| 01820 | HCPCS | Covered |
| 01829 | HCPCS | Covered |
| 01860 | HCPCS | Covered |
| 01916 | HCPCS | Covered |
| 01920 | HCPCS | Covered |
| 01922 | HCPCS | Covered |
| 01930 | HCPCS | Covered |
| 01937 | HCPCS | Covered |
| 01938 | HCPCS | Covered |
| 01939 | HCPCS | Covered |
| 01940 | HCPCS | Covered |
| 01941 | HCPCS | Covered |
| 01942 | HCPCS | Covered |
| 01991 | HCPCS | Covered |
| 01992 | HCPCS | Covered |
| 01999 | HCPCS | Covered |
| A40.3 | ICD10CM | Covered |
| A40.9 | ICD10CM | Covered |
| A41.01 | ICD10CM | Covered |
| A41.02 | ICD10CM | Covered |
| A41.1 | ICD10CM | Covered |
| A41.2 | ICD10CM | Covered |
| A41.3 | ICD10CM | Covered |
| A41.4 | ICD10CM | Covered |
| A41.50 | ICD10CM | Covered |
| A41.51 | ICD10CM | Covered |
| A41.52 | ICD10CM | Covered |
| A41.53 | ICD10CM | Covered |
| A41.54 | ICD10CM | Covered |
| A41.59 | ICD10CM | Covered |
| A41.89 | ICD10CM | Covered |
| A41.9 | ICD10CM | Covered |
| E00.0 | ICD10CM | Covered |
| E00.1 | ICD10CM | Covered |
| E00.2 | ICD10CM | Covered |
| E00.9 | 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 |
| E03.8 | ICD10CM | Covered |
| E03.9 | 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 |
| E05.90 | ICD10CM | Covered |
| E05.91 | 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 |
| E10.36 | ICD10CM | Covered |
| E10.39 | ICD10CM | Covered |
| E10.40 | ICD10CM | Covered |
| E10.49 | ICD10CM | Covered |
| E10.51 | ICD10CM | Covered |
| E10.59 | ICD10CM | Covered |
| E10.618 | ICD10CM | Covered |
| E10.620 | ICD10CM | Covered |
| E10.621 | ICD10CM | Covered |
| E10.622 | ICD10CM | Covered |
| E10.628 | ICD10CM | Covered |
| E10.630 | ICD10CM | Covered |
| E10.638 | ICD10CM | Covered |
| E10.641 | ICD10CM | Covered |
| E10.649 | ICD10CM | Covered |
| E10.65 | ICD10CM | Covered |
| E10.69 | ICD10CM | Covered |
| E10.8 | ICD10CM | Covered |
| E10.9 | ICD10CM | Covered |
| E11.00 | ICD10CM | Covered |
| E11.01 | ICD10CM | Covered |
| E11.10 | ICD10CM | Covered |
| E11.11 | ICD10CM | Covered |
| E11.21 | ICD10CM | Covered |
| E11.22 | ICD10CM | Covered |
| E11.29 | ICD10CM | Covered |
| E11.311 | ICD10CM | Covered |
| E11.319 | ICD10CM | Covered |
| E11.36 | ICD10CM | Covered |
| E11.39 | ICD10CM | Covered |
| E11.40 | ICD10CM | Covered |
| E11.49 | ICD10CM | Covered |
| E11.51 | ICD10CM | Covered |
| E11.59 | ICD10CM | Covered |
| E11.618 | ICD10CM | Covered |
| E11.620 | ICD10CM | Covered |
| E11.621 | ICD10CM | Covered |
| E11.622 | ICD10CM | Covered |
| E11.628 | ICD10CM | Covered |
| E11.630 | ICD10CM | Covered |
| E11.638 | ICD10CM | Covered |
| E11.641 | ICD10CM | Covered |
| E11.649 | ICD10CM | Covered |
| E11.65 | ICD10CM | Covered |
| E11.69 | ICD10CM | Covered |
| E11.8 | 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 |
| E13.39 | ICD10CM | Covered |
| E13.40 | ICD10CM | Covered |
| E13.49 | ICD10CM | Covered |
| E13.59 | ICD10CM | Covered |
| E13.620 | ICD10CM | Covered |
| E13.621 | ICD10CM | Covered |
| E13.622 | ICD10CM | Covered |
| E13.628 | 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 |
| E15 | ICD10CM | Covered |
| E16.0 | ICD10CM | Covered |
| E16.1 | ICD10CM | Covered |
| E16.2 | ICD10CM | Covered |
| E16.3 | ICD10CM | Covered |
| E16.4 | ICD10CM | Covered |
| E16.8 | ICD10CM | Covered |
| E16.9 | ICD10CM | Covered |
| E16.A1 | ICD10CM | Covered |
| E16.A2 | ICD10CM | Covered |
| E16.A3 | ICD10CM | Covered |
| E20.0 | ICD10CM | Covered |
| E20.810 | ICD10CM | Covered |
| E20.811 | ICD10CM | Covered |
| E20.812 | ICD10CM | Covered |
| E20.818 | ICD10CM | Covered |
| E20.89 | ICD10CM | Covered |
| E20.9 | ICD10CM | Covered |
| E21.0 | ICD10CM | Covered |
| E21.1 | ICD10CM | Covered |
| E21.2 | ICD10CM | Covered |
| E21.3 | ICD10CM | Covered |
| E21.4 | ICD10CM | Covered |
| E21.5 | ICD10CM | Covered |
| E22.0 | ICD10CM | Covered |
| E22.1 | ICD10CM | Covered |
| E22.2 | ICD10CM | Covered |
| E22.8 | ICD10CM | Covered |
| E22.9 | ICD10CM | Covered |
| E23.0 | ICD10CM | Covered |
| E23.1 | ICD10CM | Covered |
| E23.2 | ICD10CM | Covered |
| E23.3 | ICD10CM | Covered |
| E23.6 | ICD10CM | Covered |
| E23.7 | ICD10CM | Covered |
| E24.0 | ICD10CM | Covered |
| E24.1 | ICD10CM | Covered |
| E24.2 | ICD10CM | Covered |
| E24.3 | ICD10CM | Covered |
| E24.4 | ICD10CM | Covered |
| E24.8 | ICD10CM | Covered |
| E24.9 | ICD10CM | Covered |
| E25.0 | ICD10CM | Covered |
| E25.8 | ICD10CM | Covered |
| E25.9 | 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 |
| E26.9 | ICD10CM | Covered |
| E27.0 | ICD10CM | Covered |
| E27.1 | ICD10CM | Covered |
| E27.2 | ICD10CM | Covered |
| E27.3 | ICD10CM | Covered |
| E27.40 | ICD10CM | Covered |
| E27.49 | ICD10CM | Covered |
| E27.5 | ICD10CM | Covered |
| E27.8 | ICD10CM | Covered |
| E27.9 | ICD10CM | Covered |
| E32.0 | ICD10CM | Covered |
| E32.1 | ICD10CM | Covered |
| E32.8 | ICD10CM | Covered |
| E32.9 | ICD10CM | Covered |
| E34.4 | ICD10CM | Covered |
| E35 | ICD10CM | Covered |
| E66.01 | ICD10CM | Covered |
| E66.2 | ICD10CM | Covered |
| E66.813 | ICD10CM | Covered |
| E84.0 | ICD10CM | Covered |
| E84.11 | ICD10CM | Covered |
| E84.9 | ICD10CM | Covered |
| E86.0 | ICD10CM | Covered |
| E86.1 | ICD10CM | Covered |
| E86.9 | 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 |
| E87.70 | ICD10CM | Covered |
| E87.71 | ICD10CM | Covered |
| E87.79 | ICD10CM | Covered |
| E87.8 | ICD10CM | Covered |
| E89.0 | ICD10CM | Covered |
| E89.1 | ICD10CM | Covered |
| E89.2 | ICD10CM | Covered |
| E89.3 | ICD10CM | Covered |
| E89.6 | ICD10CM | Covered |
| F01.50 | ICD10CM | Covered |
| F01.511 | ICD10CM | Covered |
| F01.518 | ICD10CM | Covered |
| F01.52 | ICD10CM | Covered |
| F01.53 | ICD10CM | Covered |
| F01.54 | ICD10CM | Covered |
| F01.A0 | ICD10CM | Covered |
| F01.A11 | ICD10CM | Covered |
| F01.A18 | ICD10CM | Covered |
| F01.A2 | ICD10CM | Covered |
| F01.A3 | ICD10CM | Covered |
| F01.A4 | ICD10CM | Covered |
| F01.B0 | ICD10CM | Covered |
| F01.B11 | ICD10CM | Covered |
| F01.B18 | ICD10CM | Covered |
| F01.B2 | ICD10CM | Covered |
| F01.B3 | ICD10CM | Covered |
| F01.B4 | ICD10CM | Covered |
| F01.C0 | ICD10CM | Covered |
| F01.C11 | ICD10CM | Covered |
| F01.C18 | ICD10CM | Covered |
| F01.C2 | ICD10CM | Covered |
| F01.C3 | ICD10CM | Covered |
| F01.C4 | ICD10CM | Covered |
| F02.80 | ICD10CM | Covered |
| F02.811 | ICD10CM | Covered |
| F02.818 | ICD10CM | Covered |
| F02.82 | ICD10CM | Covered |
| F02.83 | ICD10CM | Covered |
| F02.84 | ICD10CM | Covered |
| F02.A0 | ICD10CM | Covered |
| F02.A11 | ICD10CM | Covered |
| F02.A18 | ICD10CM | Covered |
| F02.A2 | ICD10CM | Covered |
| F02.A3 | ICD10CM | Covered |
| F02.A4 | ICD10CM | Covered |
| F02.B0 | ICD10CM | Covered |
| F02.B11 | ICD10CM | Covered |
| F02.B18 | ICD10CM | Covered |
| F02.B2 | ICD10CM | Covered |
| F02.B3 | ICD10CM | Covered |
| F02.B4 | ICD10CM | Covered |
| F02.C0 | ICD10CM | Covered |
| F02.C11 | ICD10CM | Covered |
| F02.C18 | ICD10CM | Covered |
| F02.C2 | ICD10CM | Covered |
| F02.C3 | ICD10CM | Covered |
| F02.C4 | ICD10CM | Covered |
| F03.90 | ICD10CM | Covered |
| F03.911 | ICD10CM | Covered |
| F03.918 | ICD10CM | Covered |
| F03.92 | ICD10CM | Covered |
| F03.93 | ICD10CM | Covered |
| F03.94 | ICD10CM | Covered |
| F03.A0 | ICD10CM | Covered |
| F03.A11 | ICD10CM | Covered |
| F03.A18 | ICD10CM | Covered |
| F03.A2 | ICD10CM | Covered |
| F03.A3 | ICD10CM | Covered |
| F03.A4 | ICD10CM | Covered |
| F03.B0 | ICD10CM | Covered |
| F03.B11 | ICD10CM | Covered |
| F03.B18 | ICD10CM | Covered |
| F03.B2 | ICD10CM | Covered |
| F03.B3 | ICD10CM | Covered |
| F03.B4 | ICD10CM | Covered |
| F03.C0 | ICD10CM | Covered |
| F03.C11 | ICD10CM | Covered |
| F03.C18 | ICD10CM | Covered |
| F03.C2 | ICD10CM | Covered |
| F03.C3 | ICD10CM | Covered |
| F03.C4 | ICD10CM | Covered |
| F04 | ICD10CM | Covered |
| F05 | ICD10CM | Covered |
| F06.0 | ICD10CM | Covered |
| F06.1 | ICD10CM | Covered |
| F06.2 | ICD10CM | Covered |
| F06.30 | ICD10CM | Covered |
| F06.31 | ICD10CM | Covered |
| F06.32 | ICD10CM | Covered |
| F06.33 | ICD10CM | Covered |
| F06.34 | ICD10CM | Covered |
| F06.4 | ICD10CM | Covered |
| F06.8 | ICD10CM | Covered |
| F10.10 | ICD10CM | Covered |
| F10.120 | ICD10CM | Covered |
| F10.121 | ICD10CM | Covered |
| F10.129 | ICD10CM | Covered |
| F10.14 | ICD10CM | Covered |
| F10.150 | ICD10CM | Covered |
| F10.151 | ICD10CM | Covered |
| F10.159 | ICD10CM | Covered |
| F10.180 | ICD10CM | Covered |
| F10.181 | ICD10CM | Covered |
| F10.188 | ICD10CM | Covered |
| F10.19 | ICD10CM | Covered |
| F10.221 | ICD10CM | Covered |
| F10.230 | ICD10CM | Covered |
| F10.231 | ICD10CM | Covered |
| F10.232 | ICD10CM | Covered |
| F10.239 | ICD10CM | Covered |
| F10.24 | ICD10CM | Covered |
| F10.250 | ICD10CM | Covered |
| F10.251 | ICD10CM | Covered |
| F10.259 | ICD10CM | Covered |
| F10.26 | ICD10CM | Covered |
| F10.27 | ICD10CM | Covered |
| F10.280 | ICD10CM | Covered |
| F10.281 | ICD10CM | Covered |
| F10.288 | ICD10CM | Covered |
| F10.29 | ICD10CM | Covered |
| F10.920 | ICD10CM | Covered |
| F10.921 | ICD10CM | Covered |
| F10.929 | ICD10CM | Covered |
| F10.94 | ICD10CM | Covered |
| F10.950 | ICD10CM | Covered |
| F10.951 | ICD10CM | Covered |
| F10.959 | ICD10CM | Covered |
| F10.96 | ICD10CM | Covered |
| F10.97 | ICD10CM | Covered |
| F10.980 | ICD10CM | Covered |
| F10.981 | ICD10CM | Covered |
| F10.988 | ICD10CM | Covered |
| F10.99 | ICD10CM | Covered |
| F11.10 | ICD10CM | Covered |
| F11.120 | ICD10CM | Covered |
| F11.121 | ICD10CM | Covered |
| F11.122 | ICD10CM | Covered |
| F11.129 | ICD10CM | Covered |
| F11.14 | ICD10CM | Covered |
| F11.150 | ICD10CM | Covered |
| F11.151 | ICD10CM | Covered |
| F11.159 | ICD10CM | Covered |
| F11.181 | ICD10CM | Covered |
| F11.188 | ICD10CM | Covered |
| F11.19 | ICD10CM | Covered |
| F11.20 | ICD10CM | Covered |
| F11.21 | ICD10CM | Covered |
| F11.222 | ICD10CM | Covered |
| F11.259 | ICD10CM | Covered |
| F11.281 | ICD10CM | Covered |
| F11.288 | ICD10CM | Covered |
| F11.90 | ICD10CM | Covered |
| F11.920 | ICD10CM | Covered |
| F11.921 | ICD10CM | Covered |
| F11.922 | ICD10CM | Covered |
| F11.929 | ICD10CM | Covered |
| F11.93 | ICD10CM | Covered |
| F11.94 | ICD10CM | Covered |
| F11.950 | ICD10CM | Covered |
| F11.951 | ICD10CM | Covered |
| F11.959 | ICD10CM | Covered |
| F11.981 | ICD10CM | Covered |
| F11.988 | ICD10CM | Covered |
| F11.99 | ICD10CM | Covered |
| F12.10 | ICD10CM | Covered |
| F12.120 | ICD10CM | Covered |
| F12.121 | ICD10CM | Covered |
| F12.122 | ICD10CM | Covered |
| F12.129 | ICD10CM | Covered |
| F12.150 | ICD10CM | Covered |
| F12.151 | ICD10CM | Covered |
| F12.159 | ICD10CM | Covered |
| F12.180 | ICD10CM | Covered |
| F12.188 | ICD10CM | Covered |
| F12.19 | ICD10CM | Covered |
| F12.20 | ICD10CM | Covered |
| F12.21 | ICD10CM | Covered |
| F12.222 | ICD10CM | Covered |
| F12.23 | ICD10CM | Covered |
| F12.259 | ICD10CM | Covered |
| F12.280 | ICD10CM | Covered |
| F12.288 | ICD10CM | Covered |
| F12.90 | ICD10CM | Covered |
| F12.920 | ICD10CM | Covered |
| F12.921 | ICD10CM | Covered |
| F12.922 | ICD10CM | Covered |
| F12.929 | ICD10CM | Covered |
| F12.93 | ICD10CM | Covered |
| F12.950 | ICD10CM | Covered |
| F12.951 | ICD10CM | Covered |
| F12.959 | ICD10CM | Covered |
| F12.980 | ICD10CM | Covered |
| F12.988 | ICD10CM | Covered |
| F12.99 | ICD10CM | Covered |
| F13.10 | ICD10CM | Covered |
| F13.120 | ICD10CM | Covered |
| F13.121 | ICD10CM | Covered |
| F13.129 | ICD10CM | Covered |
| F13.14 | ICD10CM | Covered |
| F13.150 | ICD10CM | Covered |
| F13.151 | ICD10CM | Covered |
| F13.159 | ICD10CM | Covered |
| F13.180 | ICD10CM | Covered |
| F13.181 | ICD10CM | Covered |
| F13.188 | ICD10CM | Covered |
| F13.19 | ICD10CM | Covered |
| F13.20 | ICD10CM | Covered |
| F13.21 | ICD10CM | Covered |
| F13.259 | ICD10CM | Covered |
| F13.280 | ICD10CM | Covered |
| F13.281 | ICD10CM | Covered |
| F13.288 | ICD10CM | Covered |
| F13.90 | ICD10CM | Covered |
| F13.920 | ICD10CM | Covered |
| F13.921 | ICD10CM | Covered |
| F13.929 | ICD10CM | Covered |
| F13.930 | ICD10CM | Covered |
| F13.931 | ICD10CM | Covered |
| F13.932 | ICD10CM | Covered |
| F13.939 | ICD10CM | Covered |
| F13.94 | ICD10CM | Covered |
| F13.950 | ICD10CM | Covered |
| F13.951 | ICD10CM | Covered |
| F13.959 | ICD10CM | Covered |
| F13.96 | ICD10CM | Covered |
| F13.97 | ICD10CM | Covered |
| F13.980 | ICD10CM | Covered |
| F13.981 | ICD10CM | Covered |
| F13.988 | ICD10CM | Covered |
| F13.99 | ICD10CM | Covered |
| F14.10 | ICD10CM | Covered |
| F14.120 | ICD10CM | Covered |
| F14.121 | ICD10CM | Covered |
| F14.122 | ICD10CM | Covered |
| F14.129 | ICD10CM | Covered |
| F14.14 | ICD10CM | Covered |
| F14.150 | ICD10CM | Covered |
| F14.151 | ICD10CM | Covered |
| F14.159 | ICD10CM | Covered |
| F14.180 | ICD10CM | Covered |
| F14.181 | ICD10CM | Covered |
| F14.188 | ICD10CM | Covered |
| F14.19 | ICD10CM | Covered |
| F14.20 | ICD10CM | Covered |
| F14.21 | ICD10CM | Covered |
| F14.222 | ICD10CM | Covered |
| F14.259 | ICD10CM | Covered |
| F14.280 | ICD10CM | Covered |
| F14.281 | ICD10CM | Covered |
| F14.288 | ICD10CM | Covered |
| F14.90 | ICD10CM | Covered |
| F14.920 | ICD10CM | Covered |
| F14.921 | ICD10CM | Covered |
| F14.922 | ICD10CM | Covered |
| F14.929 | ICD10CM | Covered |
| F14.94 | ICD10CM | Covered |
| F14.950 | ICD10CM | Covered |
| F14.951 | ICD10CM | Covered |
| F14.959 | ICD10CM | Covered |
| F14.980 | ICD10CM | Covered |
| F14.981 | ICD10CM | Covered |
| F14.988 | ICD10CM | Covered |
| F14.99 | ICD10CM | Covered |
| F15.10 | ICD10CM | Covered |
| F15.120 | ICD10CM | Covered |
| F15.121 | ICD10CM | Covered |
| F15.122 | ICD10CM | Covered |
| F15.129 | ICD10CM | Covered |
| F15.14 | ICD10CM | Covered |
| F15.150 | ICD10CM | Covered |
| F15.151 | ICD10CM | Covered |
| F15.159 | ICD10CM | Covered |
| F15.180 | ICD10CM | Covered |
| F15.181 | ICD10CM | Covered |
| F15.188 | ICD10CM | Covered |
| F15.19 | ICD10CM | Covered |
| F15.20 | ICD10CM | Covered |
| F15.21 | ICD10CM | Covered |
| F15.222 | ICD10CM | Covered |
| F15.259 | ICD10CM | Covered |
| F15.280 | ICD10CM | Covered |
| F15.281 | ICD10CM | Covered |
| F15.288 | ICD10CM | Covered |
| F15.90 | ICD10CM | Covered |
| F15.920 | ICD10CM | Covered |
| F15.921 | ICD10CM | Covered |
| F15.922 | ICD10CM | Covered |
| F15.929 | ICD10CM | Covered |
| F15.93 | ICD10CM | Covered |
| F15.94 | ICD10CM | Covered |
| F15.950 | ICD10CM | Covered |
| F15.951 | ICD10CM | Covered |
| F15.959 | ICD10CM | Covered |
| F15.980 | ICD10CM | Covered |
| F15.981 | ICD10CM | Covered |
| F15.988 | ICD10CM | Covered |
| F15.99 | ICD10CM | Covered |
| F16.10 | ICD10CM | Covered |
| F16.120 | ICD10CM | Covered |
| F16.121 | ICD10CM | Covered |
| F16.122 | ICD10CM | Covered |
| F16.129 | ICD10CM | Covered |
| F16.14 | ICD10CM | Covered |
| F16.150 | ICD10CM | Covered |
| F16.151 | ICD10CM | Covered |
| F16.159 | ICD10CM | Covered |
| F16.180 | ICD10CM | Covered |
| F16.183 | ICD10CM | Covered |
| F16.188 | ICD10CM | Covered |
| F16.19 | ICD10CM | Covered |
| F16.20 | ICD10CM | Covered |
| F16.21 | ICD10CM | Covered |
| F16.259 | ICD10CM | Covered |
| F16.280 | ICD10CM | Covered |
| F16.283 | ICD10CM | Covered |
| F16.288 | ICD10CM | Covered |
| F16.90 | ICD10CM | Covered |
| F16.920 | ICD10CM | Covered |
| F16.921 | ICD10CM | Covered |
| F16.929 | ICD10CM | Covered |
| F16.94 | ICD10CM | Covered |
| F16.950 | ICD10CM | Covered |
| F16.951 | ICD10CM | Covered |
| F16.959 | ICD10CM | Covered |
| F16.980 | ICD10CM | Covered |
| F16.983 | ICD10CM | Covered |
| F16.988 | ICD10CM | Covered |
| F16.99 | ICD10CM | Covered |
| F17.203 | ICD10CM | Covered |
| F17.208 | ICD10CM | Covered |
| F17.209 | ICD10CM | Covered |
| F17.213 | ICD10CM | Covered |
| F17.218 | ICD10CM | Covered |
| F17.219 | ICD10CM | Covered |
| F17.223 | ICD10CM | Covered |
| F17.228 | ICD10CM | Covered |
| F17.229 | ICD10CM | Covered |
| F17.293 | ICD10CM | Covered |
| F17.298 | ICD10CM | Covered |
| F17.299 | ICD10CM | Covered |
| F18.120 | ICD10CM | Covered |
| F18.121 | ICD10CM | Covered |
| F18.129 | ICD10CM | Covered |
| F18.14 | ICD10CM | Covered |
| F18.150 | ICD10CM | Covered |
| F18.151 | ICD10CM | Covered |
| F18.159 | ICD10CM | Covered |
| F18.17 | ICD10CM | Covered |
| F18.180 | ICD10CM | Covered |
| F18.188 | ICD10CM | Covered |
| F18.19 | ICD10CM | Covered |
| F18.20 | ICD10CM | Covered |
| F18.21 | ICD10CM | Covered |
| F18.259 | ICD10CM | Covered |
| F18.280 | ICD10CM | Covered |
| F18.288 | ICD10CM | Covered |
| F18.920 | ICD10CM | Covered |
| F18.921 | ICD10CM | Covered |
| F18.929 | ICD10CM | Covered |
| F18.94 | ICD10CM | Covered |
| F18.950 | ICD10CM | Covered |
| F18.951 | ICD10CM | Covered |
| F18.959 | ICD10CM | Covered |
| F18.97 | ICD10CM | Covered |
| F18.980 | ICD10CM | Covered |
| F18.988 | ICD10CM | Covered |
| F18.99 | ICD10CM | Covered |
| F19.10 | ICD10CM | Covered |
| F19.120 | ICD10CM | Covered |
| F19.121 | ICD10CM | Covered |
| F19.122 | ICD10CM | Covered |
| F19.129 | ICD10CM | Covered |
| F19.14 | ICD10CM | Covered |
| F19.150 | ICD10CM | Covered |
| F19.151 | ICD10CM | Covered |
| F19.159 | ICD10CM | Covered |
| F19.16 | ICD10CM | Covered |
| F19.17 | ICD10CM | Covered |
| F19.180 | ICD10CM | Covered |
| F19.181 | ICD10CM | Covered |
| F19.188 | ICD10CM | Covered |
| F19.19 | ICD10CM | Covered |
| F19.20 | ICD10CM | Covered |
| F19.21 | ICD10CM | Covered |
| F19.222 | ICD10CM | Covered |
| F19.259 | ICD10CM | Covered |
| F19.280 | ICD10CM | Covered |
| F19.281 | ICD10CM | Covered |
| F19.288 | ICD10CM | Covered |
| F19.90 | ICD10CM | Covered |
| F19.920 | ICD10CM | Covered |
| F19.921 | ICD10CM | Covered |
| F19.922 | ICD10CM | Covered |
| F19.929 | ICD10CM | Covered |
| F19.930 | ICD10CM | Covered |
| F19.931 | ICD10CM | Covered |
| F19.932 | ICD10CM | Covered |
| F19.939 | ICD10CM | Covered |
| F19.94 | ICD10CM | Covered |
| F19.950 | ICD10CM | Covered |
| F19.951 | ICD10CM | Covered |
| F19.959 | ICD10CM | Covered |
| F19.96 | ICD10CM | Covered |
| F19.97 | ICD10CM | Covered |
| F19.980 | ICD10CM | Covered |
| F19.981 | ICD10CM | Covered |
| F19.988 | ICD10CM | Covered |
| F19.99 | ICD10CM | Covered |
| F20.0 | ICD10CM | Covered |
| F20.1 | ICD10CM | Covered |
| F20.2 | ICD10CM | Covered |
| F20.3 | ICD10CM | Covered |
| F20.5 | ICD10CM | Covered |
| F20.81 | ICD10CM | Covered |
| F20.89 | ICD10CM | Covered |
| F20.9 | ICD10CM | Covered |
| F22 | ICD10CM | Covered |
| F23 | ICD10CM | Covered |
| F24 | ICD10CM | Covered |
| F25.0 | ICD10CM | Covered |
| F25.1 | ICD10CM | Covered |
| F25.8 | ICD10CM | Covered |
| F25.9 | ICD10CM | Covered |
| F28 | ICD10CM | Covered |
| F29 | ICD10CM | Covered |
| F30.10 | ICD10CM | Covered |
| F30.11 | ICD10CM | Covered |
| F30.12 | ICD10CM | Covered |
| F30.13 | ICD10CM | Covered |
| F30.2 | ICD10CM | Covered |
| F30.3 | ICD10CM | Covered |
| F30.8 | ICD10CM | Covered |
| F30.9 | ICD10CM | Covered |
| F31.0 | ICD10CM | Covered |
| F31.10 | ICD10CM | Covered |
| F31.11 | ICD10CM | Covered |
| F31.12 | ICD10CM | Covered |
| F31.13 | ICD10CM | Covered |
| F31.2 | ICD10CM | Covered |
| F31.30 | ICD10CM | Covered |
| F31.31 | ICD10CM | Covered |
| F31.32 | ICD10CM | Covered |
| F31.4 | ICD10CM | Covered |
| F31.5 | ICD10CM | Covered |
| F31.60 | ICD10CM | Covered |
| F31.61 | ICD10CM | Covered |
| F31.62 | ICD10CM | Covered |
| F31.63 | ICD10CM | Covered |
| F31.64 | ICD10CM | Covered |
| F31.70 | ICD10CM | Covered |
| F31.71 | ICD10CM | Covered |
| F31.72 | ICD10CM | Covered |
| F31.73 | ICD10CM | Covered |
| F31.75 | ICD10CM | Covered |
| F31.77 | ICD10CM | Covered |
| F31.81 | ICD10CM | Covered |
| F31.89 | ICD10CM | Covered |
| F31.9 | ICD10CM | Covered |
| F32.0 | ICD10CM | Covered |
| F32.1 | ICD10CM | Covered |
| F32.2 | ICD10CM | Covered |
| F32.3 | ICD10CM | Covered |
| F32.4 | ICD10CM | Covered |
| F32.89 | ICD10CM | Covered |
| F32.9 | ICD10CM | Covered |
| F33.0 | ICD10CM | Covered |
| F33.1 | ICD10CM | Covered |
| F33.2 | ICD10CM | Covered |
| F33.3 | ICD10CM | Covered |
| F33.40 | ICD10CM | Covered |
| F33.41 | ICD10CM | Covered |
| F33.8 | ICD10CM | Covered |
| F33.9 | ICD10CM | Covered |
| F34.81 | ICD10CM | Covered |
| F34.89 | ICD10CM | Covered |
| F34.9 | ICD10CM | Covered |
| F39 | ICD10CM | Covered |
| F40.00 | ICD10CM | Covered |
| F40.01 | ICD10CM | Covered |
| F40.02 | ICD10CM | Covered |
| F40.10 | ICD10CM | Covered |
| F40.11 | ICD10CM | Covered |
| F40.210 | ICD10CM | Covered |
| F40.218 | ICD10CM | Covered |
| F40.220 | ICD10CM | Covered |
| F40.228 | ICD10CM | Covered |
| F40.230 | ICD10CM | Covered |
| F40.231 | ICD10CM | Covered |
| F40.232 | ICD10CM | Covered |
| F40.233 | ICD10CM | Covered |
| F40.240 | ICD10CM | Covered |
| F40.241 | ICD10CM | Covered |
| F40.242 | ICD10CM | Covered |
| F40.243 | ICD10CM | Covered |
| F40.248 | ICD10CM | Covered |
| F40.290 | ICD10CM | Covered |
| F40.291 | ICD10CM | Covered |
| F40.298 | ICD10CM | Covered |
| F40.8 | ICD10CM | Covered |
| F40.9 | ICD10CM | Covered |
| F41.0 | ICD10CM | Covered |
| F41.1 | ICD10CM | Covered |
| F41.3 | ICD10CM | Covered |
| F41.8 | ICD10CM | Covered |
| F41.9 | ICD10CM | Covered |
| F44.89 | ICD10CM | Covered |
| F44.9 | ICD10CM | Covered |
| F53.1 | ICD10CM | Covered |
| F72 | ICD10CM | Covered |
| F73 | ICD10CM | Covered |
| F78.A9 | ICD10CM | Covered |
| F79 | ICD10CM | Covered |
| F84.0 | ICD10CM | Covered |
| F84.3 | ICD10CM | Covered |
| F84.5 | ICD10CM | Covered |
| F84.8 | ICD10CM | Covered |
| F91.9 | ICD10CM | Covered |
| G06.0 | ICD10CM | Covered |
| G12.21 | ICD10CM | Covered |
| G12.25 | ICD10CM | Covered |
| G20.A1 | ICD10CM | Covered |
| G20.A2 | ICD10CM | Covered |
| G20.B1 | ICD10CM | Covered |
| G20.B2 | ICD10CM | Covered |
| G21.11 | ICD10CM | Covered |
| G21.19 | ICD10CM | Covered |
| G21.2 | ICD10CM | Covered |
| G21.3 | ICD10CM | Covered |
| G21.4 | ICD10CM | Covered |
| G21.8 | ICD10CM | Covered |
| G21.9 | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G30.1 | ICD10CM | Covered |
| G30.8 | ICD10CM | Covered |
| G30.9 | ICD10CM | Covered |
| G31.85 | ICD10CM | Covered |
| G35.A | ICD10CM | Covered |
| G35.B1 | ICD10CM | Covered |
| G35.B2 | ICD10CM | Covered |
| G35.C1 | ICD10CM | Covered |
| G35.C2 | ICD10CM | Covered |
| G40.001 | ICD10CM | Covered |
| G40.009 | ICD10CM | Covered |
| G40.011 | ICD10CM | Covered |
| G40.019 | ICD10CM | Covered |
| G40.101 | ICD10CM | Covered |
| G40.109 | ICD10CM | Covered |
| G40.111 | ICD10CM | Covered |
| G40.119 | ICD10CM | Covered |
| G40.201 | ICD10CM | Covered |
| G40.209 | ICD10CM | Covered |
| G40.211 | ICD10CM | Covered |
| G40.219 | ICD10CM | Covered |
| G40.301 | ICD10CM | Covered |
| G40.309 | ICD10CM | Covered |
| G40.311 | ICD10CM | Covered |
| G40.319 | ICD10CM | Covered |
| G40.401 | ICD10CM | Covered |
| G40.409 | ICD10CM | Covered |
| G40.411 | ICD10CM | Covered |
| G40.419 | ICD10CM | Covered |
| G40.501 | ICD10CM | Covered |
| G40.509 | ICD10CM | Covered |
| G40.801 | ICD10CM | Covered |
| G40.802 | ICD10CM | Covered |
| G40.803 | ICD10CM | Covered |
| G40.804 | ICD10CM | Covered |
| G40.811 | ICD10CM | Covered |
| G40.812 | ICD10CM | Covered |
| G40.813 | ICD10CM | Covered |
| G40.814 | ICD10CM | Covered |
| G40.821 | ICD10CM | Covered |
| G40.822 | ICD10CM | Covered |
| G40.823 | ICD10CM | Covered |
| G40.824 | ICD10CM | Covered |
| G40.89 | ICD10CM | Covered |
| G40.901 | ICD10CM | Covered |
| G40.909 | ICD10CM | Covered |
| G40.911 | ICD10CM | Covered |
| G40.919 | ICD10CM | Covered |
| G40.A01 | ICD10CM | Covered |
| G40.A09 | ICD10CM | Covered |
| G40.A11 | ICD10CM | Covered |
| G40.A19 | ICD10CM | Covered |
| G40.B01 | ICD10CM | Covered |
| G40.B09 | ICD10CM | Covered |
| G40.B11 | ICD10CM | Covered |
| G40.B19 | ICD10CM | Covered |
| G45.0 | ICD10CM | Covered |
| G45.1 | ICD10CM | Covered |
| G45.2 | ICD10CM | Covered |
| G45.4 | ICD10CM | Covered |
| G45.8 | ICD10CM | Covered |
| G45.9 | ICD10CM | Covered |
| G46.0 | ICD10CM | Covered |
| G46.1 | ICD10CM | Covered |
| G46.2 | ICD10CM | Covered |
| G46.3 | ICD10CM | Covered |
| G46.4 | ICD10CM | Covered |
| G46.5 | ICD10CM | Covered |
| G46.6 | ICD10CM | Covered |
| G46.7 | ICD10CM | Covered |
| G46.8 | ICD10CM | Covered |
| G47.33 | ICD10CM | Covered |
| G70.00 | ICD10CM | Covered |
| G70.80 | ICD10CM | Covered |
| G70.81 | ICD10CM | Covered |
| G73.1 | ICD10CM | Covered |
| G80.9 | ICD10CM | Covered |
| G97.81 | ICD10CM | Covered |
| H35.20 | ICD10CM | Covered |
| H35.21 | ICD10CM | Covered |
| H35.22 | ICD10CM | Covered |
| H35.23 | ICD10CM | Covered |
| H35.3210 | ICD10CM | Covered |
| H35.3211 | ICD10CM | Covered |
| H35.3212 | ICD10CM | Covered |
| H35.3213 | ICD10CM | Covered |
| H35.3220 | ICD10CM | Covered |
| H35.3221 | ICD10CM | Covered |
| H35.3222 | ICD10CM | Covered |
| H35.3223 | ICD10CM | Covered |
| H35.3230 | ICD10CM | Covered |
| H35.3231 | ICD10CM | Covered |
| H35.3232 | ICD10CM | Covered |
| H35.3233 | ICD10CM | Covered |
| H35.341 | ICD10CM | Covered |
| H35.342 | ICD10CM | Covered |
| H35.343 | ICD10CM | Covered |
| H35.349 | ICD10CM | Covered |
| H35.371 | ICD10CM | Covered |
| H35.372 | ICD10CM | Covered |
| H35.373 | ICD10CM | Covered |
| H35.379 | ICD10CM | Covered |
| I01.0 | ICD10CM | Covered |
| I01.1 | ICD10CM | Covered |
| I01.2 | ICD10CM | Covered |
| I05.0 | ICD10CM | Covered |
| I05.1 | ICD10CM | Covered |
| I05.2 | ICD10CM | Covered |
| I05.8 | ICD10CM | Covered |
| I05.9 | ICD10CM | Covered |
| I08.1 | ICD10CM | Covered |
| I08.2 | ICD10CM | Covered |
| I08.3 | ICD10CM | Covered |
| I08.8 | ICD10CM | Covered |
| I08.9 | ICD10CM | Covered |
| I09.1 | 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 |
| I20.0 | ICD10CM | Covered |
| I20.1 | ICD10CM | Covered |
| I20.2 | ICD10CM | Covered |
| I20.81 | ICD10CM | Covered |
| I20.89 | 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 |
| I21.3 | ICD10CM | Covered |
| I21.4 | ICD10CM | Covered |
| I21.9 | ICD10CM | Covered |
| I21.B | ICD10CM | Covered |
| I22.0 | ICD10CM | Covered |
| I22.1 | ICD10CM | Covered |
| I22.2 | ICD10CM | Covered |
| I22.8 | ICD10CM | Covered |
| I22.9 | ICD10CM | Covered |
| I24.0 | ICD10CM | Covered |
| I24.1 | ICD10CM | Covered |
| I24.81 | ICD10CM | Covered |
| I24.89 | 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 |
| I25.700 | ICD10CM | Covered |
| I25.701 | ICD10CM | Covered |
| I25.702 | ICD10CM | Covered |
| I25.708 | 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 |
| I25.82 | ICD10CM | Covered |
| I25.83 | ICD10CM | Covered |
| I25.84 | ICD10CM | Covered |
| I25.85 | ICD10CM | Covered |
| I25.89 | ICD10CM | Covered |
| I25.9 | ICD10CM | Covered |
| I26.03 | ICD10CM | Covered |
| I26.04 | ICD10CM | Covered |
| I26.09 | ICD10CM | Covered |
| I27.0 | ICD10CM | Covered |
| I27.81 | ICD10CM | Covered |
| I27.82 | ICD10CM | Covered |
| I27.9 | ICD10CM | Covered |
| I30.0 | ICD10CM | Covered |