About this policy
The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD.
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.
| Code | Code system | Status in this policy |
|---|---|---|
| 37236 | HCPCS | Covered |
| 37237 | HCPCS | Covered |
| 37238 | HCPCS | Covered |
| 37239 | HCPCS | Covered |
| 37254 | HCPCS | Covered |
| 37255 | HCPCS | Covered |
| 37256 | HCPCS | Covered |
| 37257 | HCPCS | Covered |
| 37258 | HCPCS | Covered |
| 37259 | HCPCS | Covered |
| 37260 | HCPCS | Covered |
| 37261 | HCPCS | Covered |
| 37262 | HCPCS | Covered |
| 37263 | HCPCS | Covered |
| 37264 | HCPCS | Covered |
| 37265 | HCPCS | Covered |
| 37266 | HCPCS | Covered |
| 37267 | HCPCS | Covered |
| 37268 | HCPCS | Covered |
| 37269 | HCPCS | Covered |
| 37270 | HCPCS | Covered |
| 37271 | HCPCS | Covered |
| 37272 | HCPCS | Covered |
| 37273 | HCPCS | Covered |
| 37274 | HCPCS | Covered |
| 37275 | HCPCS | Covered |
| 37276 | HCPCS | Covered |
| 37277 | HCPCS | Covered |
| 37278 | HCPCS | Covered |
| 37279 | HCPCS | Covered |
| 37280 | HCPCS | Covered |
| 37281 | HCPCS | Covered |
| 37282 | HCPCS | Covered |
| 37283 | HCPCS | Covered |
| 37284 | HCPCS | Covered |
| 37285 | HCPCS | Covered |
| 37286 | HCPCS | Covered |
| 37287 | HCPCS | Covered |
| 37288 | HCPCS | Covered |
| 37289 | HCPCS | Covered |
| 37290 | HCPCS | Covered |
| 37291 | HCPCS | Covered |
| 37292 | HCPCS | Covered |
| 37293 | HCPCS | Covered |
| 37294 | HCPCS | Covered |
| 37295 | HCPCS | Covered |
| 37296 | HCPCS | Covered |
| 37297 | HCPCS | Covered |
| 37298 | HCPCS | Covered |
| 37299 | HCPCS | Covered |
| E10.59 | ICD10CM | Covered |
| E11.59 | ICD10CM | Covered |
| E13.59 | ICD10CM | Covered |
| G45.8 | 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 |
| I70.0 | ICD10CM | Covered |
| I70.1 | ICD10CM | Covered |
| I70.211 | ICD10CM | Covered |
| I70.212 | ICD10CM | Covered |
| I70.213 | ICD10CM | Covered |
| I70.218 | ICD10CM | Covered |
| I70.219 | ICD10CM | Covered |
| I70.221 | ICD10CM | Covered |
| I70.222 | ICD10CM | Covered |
| I70.223 | ICD10CM | Covered |
| I70.228 | ICD10CM | Covered |
| I70.231 | ICD10CM | Covered |
| I70.232 | ICD10CM | Covered |
| I70.233 | ICD10CM | Covered |
| I70.234 | ICD10CM | Covered |
| I70.235 | ICD10CM | Covered |
| I70.238 | ICD10CM | Covered |
| I70.241 | ICD10CM | Covered |
| I70.242 | ICD10CM | Covered |
| I70.243 | ICD10CM | Covered |
| I70.244 | ICD10CM | Covered |
| I70.245 | ICD10CM | Covered |
| I70.248 | ICD10CM | Covered |
| I70.25 | ICD10CM | Covered |
| I70.261 | ICD10CM | Covered |
| I70.262 | ICD10CM | Covered |
| I70.263 | ICD10CM | Covered |
| I70.268 | ICD10CM | Covered |
| I70.269 | ICD10CM | Covered |
| I70.301 | ICD10CM | Covered |
| I70.302 | ICD10CM | Covered |
| I70.303 | ICD10CM | Covered |
| I70.311 | ICD10CM | Covered |
| I70.312 | ICD10CM | Covered |
| I70.313 | ICD10CM | Covered |
| I70.321 | ICD10CM | Covered |
| I70.322 | ICD10CM | Covered |
| I70.323 | ICD10CM | Covered |
| I70.331 | ICD10CM | Covered |
| I70.332 | ICD10CM | Covered |
| I70.333 | ICD10CM | Covered |
| I70.334 | ICD10CM | Covered |
| I70.335 | ICD10CM | Covered |
| I70.338 | ICD10CM | Covered |
| I70.341 | ICD10CM | Covered |
| I70.342 | ICD10CM | Covered |
| I70.343 | ICD10CM | Covered |
| I70.344 | ICD10CM | Covered |
| I70.345 | ICD10CM | Covered |
| I70.348 | ICD10CM | Covered |
| I70.361 | ICD10CM | Covered |
| I70.362 | ICD10CM | Covered |
| I70.363 | ICD10CM | Covered |
| I70.401 | ICD10CM | Covered |
| I70.402 | ICD10CM | Covered |
| I70.403 | ICD10CM | Covered |
| I70.411 | ICD10CM | Covered |
| I70.412 | ICD10CM | Covered |
| I70.413 | ICD10CM | Covered |
| I70.421 | ICD10CM | Covered |
| I70.422 | ICD10CM | Covered |
| I70.423 | ICD10CM | Covered |
| I70.431 | ICD10CM | Covered |
| I70.432 | ICD10CM | Covered |
| I70.433 | ICD10CM | Covered |
| I70.434 | ICD10CM | Covered |
| I70.435 | ICD10CM | Covered |
| I70.438 | ICD10CM | Covered |
| I70.441 | ICD10CM | Covered |
| I70.442 | ICD10CM | Covered |
| I70.443 | ICD10CM | Covered |
| I70.444 | ICD10CM | Covered |
| I70.445 | ICD10CM | Covered |
| I70.448 | ICD10CM | Covered |
| I70.461 | ICD10CM | Covered |
| I70.462 | ICD10CM | Covered |
| I70.463 | ICD10CM | Covered |
| I70.491 | ICD10CM | Covered |
| I70.492 | ICD10CM | Covered |
| I70.493 | ICD10CM | Covered |
| I70.501 | ICD10CM | Covered |
| I70.502 | ICD10CM | Covered |
| I70.503 | ICD10CM | Covered |
| I70.511 | ICD10CM | Covered |
| I70.512 | ICD10CM | Covered |
| I70.513 | ICD10CM | Covered |
| I70.521 | ICD10CM | Covered |
| I70.522 | ICD10CM | Covered |
| I70.523 | ICD10CM | Covered |
| I70.531 | ICD10CM | Covered |
| I70.532 | ICD10CM | Covered |
| I70.533 | ICD10CM | Covered |
| I70.534 | ICD10CM | Covered |
| I70.535 | ICD10CM | Covered |
| I70.538 | ICD10CM | Covered |
| I70.541 | ICD10CM | Covered |
| I70.542 | ICD10CM | Covered |
| I70.543 | ICD10CM | Covered |
| I70.544 | ICD10CM | Covered |
| I70.545 | ICD10CM | Covered |
| I70.548 | ICD10CM | Covered |
| I70.561 | ICD10CM | Covered |
| I70.562 | ICD10CM | Covered |
| I70.563 | ICD10CM | Covered |
| I70.591 | ICD10CM | Covered |
| I70.592 | ICD10CM | Covered |
| I70.593 | ICD10CM | Covered |
| I70.601 | ICD10CM | Covered |
| I70.602 | ICD10CM | Covered |
| I70.603 | ICD10CM | Covered |
| I70.611 | ICD10CM | Covered |
| I70.612 | ICD10CM | Covered |
| I70.613 | ICD10CM | Covered |
| I70.621 | ICD10CM | Covered |
| I70.622 | ICD10CM | Covered |
| I70.623 | ICD10CM | Covered |
| I70.631 | ICD10CM | Covered |
| I70.632 | ICD10CM | Covered |
| I70.633 | ICD10CM | Covered |
| I70.634 | ICD10CM | Covered |
| I70.635 | ICD10CM | Covered |
| I70.638 | ICD10CM | Covered |
| I70.641 | ICD10CM | Covered |
| I70.642 | ICD10CM | Covered |
| I70.643 | ICD10CM | Covered |
| I70.644 | ICD10CM | Covered |
| I70.645 | ICD10CM | Covered |
| I70.648 | ICD10CM | Covered |
| I70.661 | ICD10CM | Covered |
| I70.662 | ICD10CM | Covered |
| I70.663 | ICD10CM | Covered |
| I70.691 | ICD10CM | Covered |
| I70.692 | ICD10CM | Covered |
| I70.693 | ICD10CM | Covered |
| I70.701 | ICD10CM | Covered |
| I70.702 | ICD10CM | Covered |
| I70.703 | ICD10CM | Covered |
| I70.711 | ICD10CM | Covered |
| I70.712 | ICD10CM | Covered |
| I70.713 | ICD10CM | Covered |
| I70.721 | ICD10CM | Covered |
| I70.722 | ICD10CM | Covered |
| I70.723 | ICD10CM | Covered |
| I70.731 | ICD10CM | Covered |
| I70.732 | ICD10CM | Covered |
| I70.733 | ICD10CM | Covered |
| I70.734 | ICD10CM | Covered |
| I70.735 | ICD10CM | Covered |
| I70.738 | ICD10CM | Covered |
| I70.741 | ICD10CM | Covered |
| I70.742 | ICD10CM | Covered |
| I70.743 | ICD10CM | Covered |
| I70.744 | ICD10CM | Covered |
| I70.745 | ICD10CM | Covered |
| I70.748 | ICD10CM | Covered |
| I70.761 | ICD10CM | Covered |
| I70.762 | ICD10CM | Covered |
| I70.763 | ICD10CM | Covered |
| I70.791 | ICD10CM | Covered |
| I70.792 | ICD10CM | Covered |
| I70.793 | ICD10CM | Covered |
| I71.010 | ICD10CM | Covered |
| I71.011 | ICD10CM | Covered |
| I71.012 | ICD10CM | Covered |
| I71.02 | ICD10CM | Covered |
| I71.31 | ICD10CM | Covered |
| I71.32 | ICD10CM | Covered |
| I71.33 | ICD10CM | Covered |
| I71.41 | ICD10CM | Covered |
| I71.42 | ICD10CM | Covered |
| I71.43 | ICD10CM | Covered |
| I72.1 | ICD10CM | Covered |
| I72.2 | ICD10CM | Covered |
| I72.3 | ICD10CM | Covered |
| I72.4 | ICD10CM | Covered |
| I74.2 | ICD10CM | Covered |
| I74.3 | ICD10CM | Covered |
| I74.5 | ICD10CM | Covered |
| I74.8 | ICD10CM | Covered |
| I75.81 | ICD10CM | Covered |
| I77.3 | ICD10CM | Covered |
| I77.72 | ICD10CM | Covered |
| I77.73 | ICD10CM | Covered |
| I80.11 | ICD10CM | Covered |
| I80.12 | ICD10CM | Covered |
| I80.13 | ICD10CM | Covered |
| I80.211 | ICD10CM | Covered |
| I80.212 | ICD10CM | Covered |
| I80.213 | ICD10CM | Covered |
| I80.8 | ICD10CM | Covered |
| I82.210 | ICD10CM | Covered |
| I82.220 | ICD10CM | Covered |
| I82.221 | ICD10CM | Covered |
| I82.290 | ICD10CM | Covered |
| I82.401 | ICD10CM | Covered |
| I82.402 | ICD10CM | Covered |
| I82.403 | ICD10CM | Covered |
| I82.411 | ICD10CM | Covered |
| I82.412 | ICD10CM | Covered |
| I82.413 | ICD10CM | Covered |
| I82.421 | ICD10CM | Covered |
| I82.422 | ICD10CM | Covered |
| I82.423 | ICD10CM | Covered |
| I82.A11 | ICD10CM | Covered |
| I82.A12 | ICD10CM | Covered |
| I82.A13 | ICD10CM | Covered |
| I82.B11 | ICD10CM | Covered |
| I82.B12 | ICD10CM | Covered |
| I82.B13 | ICD10CM | Covered |
| I87.1 | ICD10CM | Covered |
| J81.0 | ICD10CM | Covered |
| K55.011 | ICD10CM | Covered |
| K55.012 | ICD10CM | Covered |
| K55.019 | ICD10CM | Covered |
| K55.021 | ICD10CM | Covered |
| K55.022 | ICD10CM | Covered |
| K55.029 | ICD10CM | Covered |
| K55.031 | ICD10CM | Covered |
| K55.032 | ICD10CM | Covered |
| K55.039 | ICD10CM | Covered |
| K55.041 | ICD10CM | Covered |
| K55.042 | ICD10CM | Covered |
| K55.049 | ICD10CM | Covered |
| K55.051 | ICD10CM | Covered |
| K55.052 | ICD10CM | Covered |
| K55.059 | ICD10CM | Covered |
| K55.061 | ICD10CM | Covered |
| K55.062 | ICD10CM | Covered |
| K55.069 | ICD10CM | Covered |
| K55.1 | ICD10CM | Covered |
| K55.8 | ICD10CM | Covered |
| K55.9 | ICD10CM | Covered |
| N17.8 | ICD10CM | Covered |
| N17.9 | ICD10CM | Covered |
| N26.2 | ICD10CM | Covered |
| Q25.21 | ICD10CM | Covered |
| Q25.29 | ICD10CM | Covered |
| Q25.3 | ICD10CM | Covered |
| Q25.5 | ICD10CM | Covered |
| Q25.71 | ICD10CM | Covered |
| Q26.0 | ICD10CM | Covered |
| Q26.1 | ICD10CM | Covered |
| Q26.8 | ICD10CM | Covered |
| Q27.1 | ICD10CM | Covered |
| Q27.2 | ICD10CM | Covered |
| Q27.34 | ICD10CM | Covered |
| T66.XXXA | ICD10CM | Covered |
| T80.818A | ICD10CM | Covered |
| T82.510A | ICD10CM | Covered |
| T82.511A | ICD10CM | Covered |
| T82.520A | ICD10CM | Covered |
| T82.521A | ICD10CM | Covered |
| T82.530A | ICD10CM | Covered |
| T82.531A | ICD10CM | Covered |
| T82.590A | ICD10CM | Covered |
| T82.591A | ICD10CM | Covered |
| T82.818A | ICD10CM | Covered |
| T82.828A | ICD10CM | Covered |
| T82.838A | ICD10CM | Covered |
| T82.848A | ICD10CM | Covered |
| T82.858A | ICD10CM | Covered |
| T82.868A | ICD10CM | Covered |
| T82.898A | ICD10CM | Covered |
| T86.10 | ICD10CM | Covered |
| T86.11 | ICD10CM | Covered |
| T86.12 | ICD10CM | Covered |
| T86.13 | ICD10CM | Covered |
| T86.19 | ICD10CM | Covered |