About this policy
Jurisdiction: J15 MAC Part B. States: Kentucky, Ohio. Type: Active 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.
Showing the first 1,000 of 4,131 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 11000 | CPT | Covered |
| 11001 | CPT | Covered |
| 11042 | CPT | Covered |
| 11043 | CPT | Covered |
| 11044 | CPT | Covered |
| 11045 | CPT | Covered |
| 11046 | CPT | Covered |
| 11047 | CPT | Covered |
| A48.0 | 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 |
| 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 |
| I70.432 | 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 |
| I70.531 | 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 |
| I70.631 | 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 |
| I70.731 | 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 |
| I73.01 | ICD10CM | Covered |
| I73.1 | ICD10CM | Covered |
| I83.001 | ICD10CM | Covered |
| I83.002 | ICD10CM | Covered |
| I83.003 | ICD10CM | Covered |
| I83.004 | ICD10CM | Covered |
| I83.011 | ICD10CM | Covered |
| I83.012 | ICD10CM | Covered |
| I83.013 | ICD10CM | Covered |
| I83.014 | ICD10CM | Covered |
| I83.021 | ICD10CM | Covered |
| I83.022 | ICD10CM | Covered |
| I83.023 | ICD10CM | Covered |
| I83.024 | ICD10CM | Covered |
| I83.201 | ICD10CM | Covered |
| I83.202 | ICD10CM | Covered |
| I83.203 | ICD10CM | Covered |
| I83.204 | ICD10CM | Covered |
| I83.211 | ICD10CM | Covered |
| I83.212 | ICD10CM | Covered |
| I83.213 | ICD10CM | Covered |
| I83.214 | ICD10CM | Covered |
| I83.221 | ICD10CM | Covered |
| I83.222 | ICD10CM | Covered |
| I83.223 | ICD10CM | Covered |
| I83.224 | ICD10CM | Covered |
| I87.011 | ICD10CM | Covered |
| I87.012 | ICD10CM | Covered |
| I87.013 | ICD10CM | Covered |
| I87.311 | ICD10CM | Covered |
| I87.312 | ICD10CM | Covered |
| I87.313 | ICD10CM | Covered |
| I87.331 | ICD10CM | Covered |
| I87.332 | ICD10CM | Covered |
| I87.333 | ICD10CM | Covered |
| I96 | ICD10CM | Covered |
| K68.11 | ICD10CM | Covered |
| L01.01 | ICD10CM | Covered |
| L01.02 | ICD10CM | Covered |
| L01.03 | ICD10CM | Covered |
| L01.1 | ICD10CM | Covered |
| L08.0 | ICD10CM | Covered |
| L08.81 | ICD10CM | Covered |
| L23.0 | ICD10CM | Covered |
| L23.1 | ICD10CM | Covered |
| L23.2 | ICD10CM | Covered |
| L23.3 | ICD10CM | Covered |
| L23.4 | ICD10CM | Covered |
| L23.5 | ICD10CM | Covered |
| L23.6 | ICD10CM | Covered |
| L23.7 | ICD10CM | Covered |
| L23.89 | ICD10CM | Covered |
| L24.0 | ICD10CM | Covered |
| L24.1 | ICD10CM | Covered |
| L24.2 | ICD10CM | Covered |
| L24.3 | ICD10CM | Covered |
| L24.4 | ICD10CM | Covered |
| L24.5 | ICD10CM | Covered |
| L24.6 | ICD10CM | Covered |
| L24.7 | ICD10CM | Covered |
| L24.81 | ICD10CM | Covered |
| L24.89 | ICD10CM | Covered |
| L25.2 | ICD10CM | Covered |
| L25.8 | ICD10CM | Covered |
| L30.0 | ICD10CM | Covered |
| L30.2 | ICD10CM | Covered |
| L30.9 | ICD10CM | Covered |
| L56.4 | ICD10CM | Covered |
| L58.0 | ICD10CM | Covered |
| L58.1 | ICD10CM | Covered |
| L59.0 | ICD10CM | Covered |
| L59.8 | ICD10CM | Covered |
| L88 | ICD10CM | Covered |
| L89.006 | ICD10CM | Covered |
| L89.010 | ICD10CM | Covered |
| L89.011 | ICD10CM | Covered |
| L89.012 | ICD10CM | Covered |
| L89.013 | ICD10CM | Covered |
| L89.014 | ICD10CM | Covered |
| L89.016 | ICD10CM | Covered |
| L89.019 | ICD10CM | Covered |
| L89.020 | ICD10CM | Covered |
| L89.021 | ICD10CM | Covered |
| L89.022 | ICD10CM | Covered |
| L89.023 | ICD10CM | Covered |
| L89.024 | ICD10CM | Covered |
| L89.026 | ICD10CM | Covered |
| L89.029 | ICD10CM | Covered |
| L89.106 | ICD10CM | Covered |
| L89.110 | ICD10CM | Covered |
| L89.111 | ICD10CM | Covered |
| L89.112 | ICD10CM | Covered |
| L89.113 | ICD10CM | Covered |
| L89.114 | ICD10CM | Covered |
| L89.116 | ICD10CM | Covered |
| L89.119 | ICD10CM | Covered |
| L89.120 | ICD10CM | Covered |
| L89.121 | ICD10CM | Covered |
| L89.122 | ICD10CM | Covered |
| L89.123 | ICD10CM | Covered |
| L89.124 | ICD10CM | Covered |
| L89.126 | ICD10CM | Covered |
| L89.129 | ICD10CM | Covered |
| L89.130 | ICD10CM | Covered |
| L89.131 | ICD10CM | Covered |
| L89.132 | ICD10CM | Covered |
| L89.133 | ICD10CM | Covered |
| L89.134 | ICD10CM | Covered |
| L89.136 | ICD10CM | Covered |
| L89.139 | ICD10CM | Covered |
| L89.140 | ICD10CM | Covered |
| L89.141 | ICD10CM | Covered |
| L89.142 | ICD10CM | Covered |
| L89.143 | ICD10CM | Covered |
| L89.144 | ICD10CM | Covered |
| L89.146 | ICD10CM | Covered |
| L89.149 | ICD10CM | Covered |
| L89.150 | ICD10CM | Covered |
| L89.151 | ICD10CM | Covered |
| L89.152 | ICD10CM | Covered |
| L89.153 | ICD10CM | Covered |
| L89.154 | ICD10CM | Covered |
| L89.156 | ICD10CM | Covered |
| L89.159 | ICD10CM | Covered |
| L89.206 | ICD10CM | Covered |
| L89.210 | ICD10CM | Covered |
| L89.211 | ICD10CM | Covered |
| L89.212 | ICD10CM | Covered |
| L89.213 | ICD10CM | Covered |
| L89.214 | ICD10CM | Covered |
| L89.216 | ICD10CM | Covered |
| L89.219 | ICD10CM | Covered |
| L89.220 | ICD10CM | Covered |
| L89.221 | ICD10CM | Covered |
| L89.222 | ICD10CM | Covered |
| L89.223 | ICD10CM | Covered |
| L89.224 | ICD10CM | Covered |
| L89.226 | ICD10CM | Covered |
| L89.229 | ICD10CM | Covered |
| L89.306 | ICD10CM | Covered |
| L89.310 | ICD10CM | Covered |
| L89.311 | ICD10CM | Covered |
| L89.312 | ICD10CM | Covered |
| L89.313 | ICD10CM | Covered |
| L89.314 | ICD10CM | Covered |
| L89.316 | ICD10CM | Covered |
| L89.319 | ICD10CM | Covered |
| L89.320 | ICD10CM | Covered |
| L89.321 | ICD10CM | Covered |
| L89.322 | ICD10CM | Covered |
| L89.323 | ICD10CM | Covered |
| L89.324 | ICD10CM | Covered |
| L89.326 | ICD10CM | Covered |
| L89.329 | ICD10CM | Covered |
| L89.40 | ICD10CM | Covered |
| L89.41 | ICD10CM | Covered |
| L89.42 | ICD10CM | Covered |
| L89.43 | ICD10CM | Covered |
| L89.44 | ICD10CM | Covered |
| L89.45 | ICD10CM | Covered |
| L89.46 | ICD10CM | Covered |
| L89.506 | ICD10CM | Covered |
| L89.510 | ICD10CM | Covered |
| L89.511 | ICD10CM | Covered |
| L89.512 | ICD10CM | Covered |
| L89.513 | ICD10CM | Covered |
| L89.514 | ICD10CM | Covered |
| L89.516 | ICD10CM | Covered |
| L89.519 | ICD10CM | Covered |
| L89.520 | ICD10CM | Covered |
| L89.521 | ICD10CM | Covered |
| L89.522 | ICD10CM | Covered |
| L89.523 | ICD10CM | Covered |
| L89.524 | ICD10CM | Covered |
| L89.526 | ICD10CM | Covered |
| L89.529 | ICD10CM | Covered |
| L89.606 | ICD10CM | Covered |
| L89.610 | ICD10CM | Covered |
| L89.611 | ICD10CM | Covered |
| L89.612 | ICD10CM | Covered |
| L89.613 | ICD10CM | Covered |
| L89.614 | ICD10CM | Covered |
| L89.616 | ICD10CM | Covered |
| L89.619 | ICD10CM | Covered |
| L89.620 | ICD10CM | Covered |
| L89.621 | ICD10CM | Covered |
| L89.622 | ICD10CM | Covered |
| L89.623 | ICD10CM | Covered |
| L89.624 | ICD10CM | Covered |
| L89.629 | ICD10CM | Covered |
| L89.810 | ICD10CM | Covered |
| L89.811 | ICD10CM | Covered |
| L89.812 | ICD10CM | Covered |
| L89.813 | ICD10CM | Covered |
| L89.814 | ICD10CM | Covered |
| L89.819 | ICD10CM | Covered |
| L89.890 | ICD10CM | Covered |
| L89.891 | ICD10CM | Covered |
| L89.892 | ICD10CM | Covered |
| L89.893 | ICD10CM | Covered |
| L89.894 | ICD10CM | Covered |
| L89.896 | ICD10CM | Covered |
| L89.899 | ICD10CM | Covered |
| L92.3 | ICD10CM | Covered |
| L92.8 | ICD10CM | Covered |
| L97.111 | ICD10CM | Covered |
| L97.112 | ICD10CM | Covered |
| L97.113 | ICD10CM | Covered |
| L97.114 | ICD10CM | Covered |
| L97.115 | ICD10CM | Covered |
| L97.116 | ICD10CM | Covered |
| L97.118 | ICD10CM | Covered |
| L97.121 | ICD10CM | Covered |
| L97.122 | ICD10CM | Covered |
| L97.123 | ICD10CM | Covered |
| L97.124 | ICD10CM | Covered |
| L97.125 | ICD10CM | Covered |
| L97.126 | ICD10CM | Covered |
| L97.128 | ICD10CM | Covered |
| L97.211 | ICD10CM | Covered |
| L97.212 | ICD10CM | Covered |
| L97.213 | ICD10CM | Covered |
| L97.214 | ICD10CM | Covered |
| L97.215 | ICD10CM | Covered |
| L97.216 | ICD10CM | Covered |
| L97.218 | ICD10CM | Covered |
| L97.221 | ICD10CM | Covered |
| L97.222 | ICD10CM | Covered |
| L97.223 | ICD10CM | Covered |
| L97.224 | ICD10CM | Covered |
| L97.225 | ICD10CM | Covered |
| L97.226 | ICD10CM | Covered |
| L97.228 | ICD10CM | Covered |
| L97.311 | ICD10CM | Covered |
| L97.312 | ICD10CM | Covered |
| L97.313 | ICD10CM | Covered |
| L97.314 | ICD10CM | Covered |
| L97.315 | ICD10CM | Covered |
| L97.316 | ICD10CM | Covered |
| L97.318 | ICD10CM | Covered |
| L97.321 | ICD10CM | Covered |
| L97.322 | ICD10CM | Covered |
| L97.323 | ICD10CM | Covered |
| L97.324 | ICD10CM | Covered |
| L97.325 | ICD10CM | Covered |
| L97.326 | ICD10CM | Covered |
| L97.328 | ICD10CM | Covered |
| L97.411 | ICD10CM | Covered |
| L97.412 | ICD10CM | Covered |
| L97.413 | ICD10CM | Covered |
| L97.414 | ICD10CM | Covered |
| L97.415 | ICD10CM | Covered |
| L97.416 | ICD10CM | Covered |
| L97.418 | ICD10CM | Covered |
| L97.421 | ICD10CM | Covered |
| L97.422 | ICD10CM | Covered |
| L97.423 | ICD10CM | Covered |
| L97.424 | ICD10CM | Covered |
| L97.425 | ICD10CM | Covered |
| L97.426 | ICD10CM | Covered |
| L97.428 | ICD10CM | Covered |
| L97.511 | ICD10CM | Covered |
| L97.512 | ICD10CM | Covered |
| L97.513 | ICD10CM | Covered |
| L97.514 | ICD10CM | Covered |
| L97.515 | ICD10CM | Covered |
| L97.516 | ICD10CM | Covered |
| L97.518 | ICD10CM | Covered |
| L97.521 | ICD10CM | Covered |
| L97.522 | ICD10CM | Covered |
| L97.523 | ICD10CM | Covered |
| L97.524 | ICD10CM | Covered |
| L97.525 | ICD10CM | Covered |
| L97.526 | ICD10CM | Covered |
| L97.528 | ICD10CM | Covered |
| L97.811 | ICD10CM | Covered |
| L97.812 | ICD10CM | Covered |
| L97.813 | ICD10CM | Covered |
| L97.814 | ICD10CM | Covered |
| L97.815 | ICD10CM | Covered |
| L97.816 | ICD10CM | Covered |
| L97.818 | ICD10CM | Covered |
| L97.821 | ICD10CM | Covered |
| L97.822 | ICD10CM | Covered |
| L97.823 | ICD10CM | Covered |
| L97.824 | ICD10CM | Covered |
| L97.825 | ICD10CM | Covered |
| L97.826 | ICD10CM | Covered |
| L97.828 | ICD10CM | Covered |
| L97.911 | ICD10CM | Covered |
| L97.912 | ICD10CM | Covered |
| L97.913 | ICD10CM | Covered |
| L97.914 | ICD10CM | Covered |
| L97.915 | ICD10CM | Covered |
| L97.916 | ICD10CM | Covered |
| L97.918 | ICD10CM | Covered |
| L97.921 | ICD10CM | Covered |
| L97.922 | ICD10CM | Covered |
| L97.923 | ICD10CM | Covered |
| L97.924 | ICD10CM | Covered |
| L97.925 | ICD10CM | Covered |
| L97.926 | ICD10CM | Covered |
| L97.928 | ICD10CM | Covered |
| L98.0 | ICD10CM | Covered |
| L98.411 | ICD10CM | Covered |
| L98.412 | ICD10CM | Covered |
| L98.413 | ICD10CM | Covered |
| L98.414 | ICD10CM | Covered |
| L98.415 | ICD10CM | Covered |
| L98.416 | ICD10CM | Covered |
| L98.421 | ICD10CM | Covered |
| L98.422 | ICD10CM | Covered |
| L98.423 | ICD10CM | Covered |
| L98.424 | ICD10CM | Covered |
| L98.425 | ICD10CM | Covered |
| L98.426 | ICD10CM | Covered |
| L98.431 | ICD10CM | Covered |
| L98.432 | ICD10CM | Covered |
| L98.433 | ICD10CM | Covered |
| L98.434 | ICD10CM | Covered |
| L98.435 | ICD10CM | Covered |
| L98.436 | ICD10CM | Covered |
| L98.441 | ICD10CM | Covered |
| L98.442 | ICD10CM | Covered |
| L98.443 | ICD10CM | Covered |
| L98.444 | ICD10CM | Covered |
| L98.445 | ICD10CM | Covered |
| L98.446 | ICD10CM | Covered |
| L98.448 | ICD10CM | Covered |
| L98.451 | ICD10CM | Covered |
| L98.452 | ICD10CM | Covered |
| L98.453 | ICD10CM | Covered |
| L98.454 | ICD10CM | Covered |
| L98.455 | ICD10CM | Covered |
| L98.456 | ICD10CM | Covered |
| L98.458 | ICD10CM | Covered |
| L98.461 | ICD10CM | Covered |
| L98.462 | ICD10CM | Covered |
| L98.463 | ICD10CM | Covered |
| L98.464 | ICD10CM | Covered |
| L98.465 | ICD10CM | Covered |
| L98.466 | ICD10CM | Covered |
| L98.468 | ICD10CM | Covered |
| L98.471 | ICD10CM | Covered |
| L98.472 | ICD10CM | Covered |
| L98.473 | ICD10CM | Covered |
| L98.474 | ICD10CM | Covered |
| L98.475 | ICD10CM | Covered |
| L98.476 | ICD10CM | Covered |
| L98.478 | ICD10CM | Covered |
| L98.491 | ICD10CM | Covered |
| L98.492 | ICD10CM | Covered |
| L98.493 | ICD10CM | Covered |
| L98.494 | ICD10CM | Covered |
| L98.495 | ICD10CM | Covered |
| L98.496 | ICD10CM | Covered |
| M46.21 | ICD10CM | Covered |
| M46.22 | ICD10CM | Covered |
| M46.23 | ICD10CM | Covered |
| M46.24 | ICD10CM | Covered |
| M46.25 | ICD10CM | Covered |
| M46.26 | ICD10CM | Covered |
| M46.27 | ICD10CM | Covered |
| M46.28 | ICD10CM | Covered |
| M72.6 | ICD10CM | Covered |
| M86.00 | ICD10CM | Covered |
| M86.011 | ICD10CM | Covered |
| M86.012 | ICD10CM | Covered |
| M86.021 | ICD10CM | Covered |
| M86.022 | ICD10CM | Covered |
| M86.031 | ICD10CM | Covered |
| M86.032 | ICD10CM | Covered |
| M86.041 | ICD10CM | Covered |
| M86.042 | ICD10CM | Covered |
| M86.051 | ICD10CM | Covered |
| M86.052 | ICD10CM | Covered |
| M86.061 | ICD10CM | Covered |
| M86.062 | ICD10CM | Covered |
| M86.071 | ICD10CM | Covered |
| M86.072 | ICD10CM | Covered |
| M86.09 | ICD10CM | Covered |
| M86.20 | ICD10CM | Covered |
| M86.211 | ICD10CM | Covered |
| M86.212 | ICD10CM | Covered |
| M86.221 | ICD10CM | Covered |
| M86.222 | ICD10CM | Covered |
| M86.231 | ICD10CM | Covered |
| M86.232 | ICD10CM | Covered |
| M86.241 | ICD10CM | Covered |
| M86.242 | ICD10CM | Covered |
| M86.251 | ICD10CM | Covered |
| M86.252 | ICD10CM | Covered |
| M86.261 | ICD10CM | Covered |
| M86.262 | ICD10CM | Covered |
| M86.271 | ICD10CM | Covered |
| M86.272 | ICD10CM | Covered |
| M86.29 | ICD10CM | Covered |
| M86.30 | ICD10CM | Covered |
| M86.311 | ICD10CM | Covered |
| M86.312 | ICD10CM | Covered |
| M86.321 | ICD10CM | Covered |
| M86.322 | ICD10CM | Covered |
| M86.331 | ICD10CM | Covered |
| M86.332 | ICD10CM | Covered |
| M86.341 | ICD10CM | Covered |
| M86.342 | ICD10CM | Covered |
| M86.351 | ICD10CM | Covered |
| M86.352 | ICD10CM | Covered |
| M86.361 | ICD10CM | Covered |
| M86.362 | ICD10CM | Covered |
| M86.371 | ICD10CM | Covered |
| M86.372 | ICD10CM | Covered |
| M86.38 | ICD10CM | Covered |
| M86.39 | ICD10CM | Covered |
| M86.40 | ICD10CM | Covered |
| M86.411 | ICD10CM | Covered |
| M86.412 | ICD10CM | Covered |
| M86.421 | ICD10CM | Covered |
| M86.422 | ICD10CM | Covered |
| M86.431 | ICD10CM | Covered |
| M86.432 | ICD10CM | Covered |
| M86.441 | ICD10CM | Covered |
| M86.442 | ICD10CM | Covered |
| M86.451 | ICD10CM | Covered |
| M86.452 | ICD10CM | Covered |
| M86.461 | ICD10CM | Covered |
| M86.462 | ICD10CM | Covered |
| M86.471 | ICD10CM | Covered |
| M86.472 | ICD10CM | Covered |
| M86.48 | ICD10CM | Covered |
| M86.49 | ICD10CM | Covered |
| M86.50 | ICD10CM | Covered |
| M86.511 | ICD10CM | Covered |
| M86.512 | ICD10CM | Covered |
| M86.521 | ICD10CM | Covered |
| M86.522 | ICD10CM | Covered |
| M86.531 | ICD10CM | Covered |
| M86.532 | ICD10CM | Covered |
| M86.541 | ICD10CM | Covered |
| M86.542 | ICD10CM | Covered |
| M86.551 | ICD10CM | Covered |
| M86.552 | ICD10CM | Covered |
| M86.561 | ICD10CM | Covered |
| M86.562 | ICD10CM | Covered |
| M86.571 | ICD10CM | Covered |
| M86.572 | ICD10CM | Covered |
| M86.58 | ICD10CM | Covered |
| M86.59 | ICD10CM | Covered |
| M86.8X0 | ICD10CM | Covered |
| M86.8X1 | ICD10CM | Covered |
| M86.8X2 | ICD10CM | Covered |
| M86.8X3 | ICD10CM | Covered |
| M86.8X4 | ICD10CM | Covered |
| M86.8X5 | ICD10CM | Covered |
| M86.8X6 | ICD10CM | Covered |
| M86.8X7 | ICD10CM | Covered |
| M86.9 | ICD10CM | Covered |
| S00.01XA | ICD10CM | Covered |
| S00.01XD | ICD10CM | Covered |
| S00.01XS | ICD10CM | Covered |
| S00.02XA | ICD10CM | Covered |
| S00.02XD | ICD10CM | Covered |
| S00.02XS | ICD10CM | Covered |
| S00.03XA | ICD10CM | Covered |
| S00.03XD | ICD10CM | Covered |
| S00.03XS | ICD10CM | Covered |
| S00.04XA | ICD10CM | Covered |
| S00.04XD | ICD10CM | Covered |
| S00.04XS | ICD10CM | Covered |
| S00.05XA | ICD10CM | Covered |
| S00.05XD | ICD10CM | Covered |
| S00.05XS | ICD10CM | Covered |
| S00.06XA | ICD10CM | Covered |
| S00.06XD | ICD10CM | Covered |
| S00.06XS | ICD10CM | Covered |
| S00.11XA | ICD10CM | Covered |
| S00.11XD | ICD10CM | Covered |
| S00.11XS | ICD10CM | Covered |
| S00.12XA | ICD10CM | Covered |
| S00.12XD | ICD10CM | Covered |
| S00.12XS | ICD10CM | Covered |
| S00.211A | ICD10CM | Covered |
| S00.211D | ICD10CM | Covered |
| S00.211S | ICD10CM | Covered |
| S00.212A | ICD10CM | Covered |
| S00.212D | ICD10CM | Covered |
| S00.212S | ICD10CM | Covered |
| S00.221A | ICD10CM | Covered |
| S00.221D | ICD10CM | Covered |
| S00.221S | ICD10CM | Covered |
| S00.222A | ICD10CM | Covered |
| S00.222D | ICD10CM | Covered |
| S00.222S | ICD10CM | Covered |
| S00.241A | ICD10CM | Covered |
| S00.241D | ICD10CM | Covered |
| S00.241S | ICD10CM | Covered |
| S00.242A | ICD10CM | Covered |
| S00.242D | ICD10CM | Covered |
| S00.242S | ICD10CM | Covered |
| S00.251A | ICD10CM | Covered |
| S00.251D | ICD10CM | Covered |
| S00.251S | ICD10CM | Covered |
| S00.252A | ICD10CM | Covered |
| S00.252D | ICD10CM | Covered |
| S00.252S | ICD10CM | Covered |
| S00.261A | ICD10CM | Covered |
| S00.261D | ICD10CM | Covered |
| S00.261S | ICD10CM | Covered |
| S00.262A | ICD10CM | Covered |
| S00.262D | ICD10CM | Covered |
| S00.262S | ICD10CM | Covered |
| S00.31XA | ICD10CM | Covered |
| S00.31XD | ICD10CM | Covered |
| S00.31XS | ICD10CM | Covered |
| S00.32XA | ICD10CM | Covered |
| S00.32XD | ICD10CM | Covered |
| S00.32XS | ICD10CM | Covered |
| S00.33XA | ICD10CM | Covered |
| S00.33XD | ICD10CM | Covered |
| S00.33XS | ICD10CM | Covered |
| S00.34XA | ICD10CM | Covered |
| S00.34XD | ICD10CM | Covered |
| S00.34XS | ICD10CM | Covered |
| S00.35XA | ICD10CM | Covered |
| S00.35XD | ICD10CM | Covered |
| S00.35XS | ICD10CM | Covered |
| S00.36XA | ICD10CM | Covered |
| S00.36XD | ICD10CM | Covered |
| S00.36XS | ICD10CM | Covered |
| S00.411A | ICD10CM | Covered |
| S00.411D | ICD10CM | Covered |
| S00.411S | ICD10CM | Covered |
| S00.412A | ICD10CM | Covered |
| S00.412D | ICD10CM | Covered |
| S00.412S | ICD10CM | Covered |
| S00.421A | ICD10CM | Covered |
| S00.421D | ICD10CM | Covered |
| S00.421S | ICD10CM | Covered |
| S00.422A | ICD10CM | Covered |
| S00.422D | ICD10CM | Covered |
| S00.422S | ICD10CM | Covered |
| S00.431A | ICD10CM | Covered |
| S00.431D | ICD10CM | Covered |
| S00.431S | ICD10CM | Covered |
| S00.432A | ICD10CM | Covered |
| S00.432D | ICD10CM | Covered |
| S00.432S | ICD10CM | Covered |
| S00.441A | ICD10CM | Covered |
| S00.441D | ICD10CM | Covered |
| S00.441S | ICD10CM | Covered |
| S00.442A | ICD10CM | Covered |
| S00.442D | ICD10CM | Covered |
| S00.442S | ICD10CM | Covered |
| S00.451A | ICD10CM | Covered |
| S00.451D | ICD10CM | Covered |
| S00.451S | ICD10CM | Covered |
| S00.452A | ICD10CM | Covered |
| S00.452D | ICD10CM | Covered |
| S00.452S | ICD10CM | Covered |
| S00.461A | ICD10CM | Covered |
| S00.461D | ICD10CM | Covered |
| S00.461S | ICD10CM | Covered |
| S00.462A | ICD10CM | Covered |
| S00.462D | ICD10CM | Covered |
| S00.462S | ICD10CM | Covered |
| S00.511A | ICD10CM | Covered |
| S00.511D | ICD10CM | Covered |
| S00.511S | ICD10CM | Covered |
| S00.512A | ICD10CM | Covered |
| S00.512D | ICD10CM | Covered |
| S00.512S | ICD10CM | Covered |
| S00.521A | ICD10CM | Covered |
| S00.521D | ICD10CM | Covered |
| S00.521S | ICD10CM | Covered |
| S00.522A | ICD10CM | Covered |
| S00.522D | ICD10CM | Covered |
| S00.522S | ICD10CM | Covered |
| S00.531A | ICD10CM | Covered |
| S00.531D | ICD10CM | Covered |
| S00.531S | ICD10CM | Covered |
| S00.532A | ICD10CM | Covered |
| S00.532D | ICD10CM | Covered |
| S00.532S | ICD10CM | Covered |
| S00.541A | ICD10CM | Covered |
| S00.541D | ICD10CM | Covered |
| S00.541S | ICD10CM | Covered |
| S00.542A | ICD10CM | Covered |
| S00.542D | ICD10CM | Covered |
| S00.542S | ICD10CM | Covered |
| S00.551A | ICD10CM | Covered |
| S00.551D | ICD10CM | Covered |
| S00.551S | ICD10CM | Covered |
| S00.552A | ICD10CM | Covered |
| S00.552D | ICD10CM | Covered |
| S00.552S | ICD10CM | Covered |
| S00.561A | ICD10CM | Covered |
| S00.561D | ICD10CM | Covered |
| S00.561S | ICD10CM | Covered |
| S00.562A | ICD10CM | Covered |
| S00.562D | ICD10CM | Covered |
| S00.562S | ICD10CM | Covered |
| S00.81XA | ICD10CM | Covered |
| S00.81XD | ICD10CM | Covered |
| S00.81XS | ICD10CM | Covered |
| S00.82XA | ICD10CM | Covered |
| S00.82XD | ICD10CM | Covered |
| S00.82XS | ICD10CM | Covered |
| S00.84XA | ICD10CM | Covered |
| S00.84XD | ICD10CM | Covered |
| S00.84XS | ICD10CM | Covered |
| S00.85XA | ICD10CM | Covered |
| S00.85XD | ICD10CM | Covered |
| S00.85XS | ICD10CM | Covered |
| S00.86XA | ICD10CM | Covered |
| S00.86XD | ICD10CM | Covered |
| S00.86XS | ICD10CM | Covered |
| S00.91XA | ICD10CM | Covered |
| S00.91XD | ICD10CM | Covered |
| S00.91XS | ICD10CM | Covered |
| S00.92XA | ICD10CM | Covered |
| S00.92XD | ICD10CM | Covered |
| S00.92XS | ICD10CM | Covered |
| S00.94XA | ICD10CM | Covered |
| S00.94XD | ICD10CM | Covered |
| S00.94XS | ICD10CM | Covered |
| S00.95XA | ICD10CM | Covered |
| S00.95XD | ICD10CM | Covered |
| S00.95XS | ICD10CM | Covered |
| S00.96XA | ICD10CM | Covered |
| S00.96XD | ICD10CM | Covered |
| S00.96XS | ICD10CM | Covered |
| S01.01XA | ICD10CM | Covered |
| S01.01XD | ICD10CM | Covered |
| S01.02XA | ICD10CM | Covered |
| S01.03XA | ICD10CM | Covered |
| S01.04XA | ICD10CM | Covered |
| S01.05XA | ICD10CM | Covered |
| S01.101A | ICD10CM | Covered |
| S01.102A | ICD10CM | Covered |
| S01.111A | ICD10CM | Covered |
| S01.111D | ICD10CM | Covered |
| S01.111S | ICD10CM | Covered |
| S01.112A | ICD10CM | Covered |
| S01.112D | ICD10CM | Covered |
| S01.112S | ICD10CM | Covered |
| S01.121A | ICD10CM | Covered |
| S01.121D | ICD10CM | Covered |
| S01.121S | ICD10CM | Covered |
| S01.122A | ICD10CM | Covered |
| S01.122D | ICD10CM | Covered |
| S01.122S | ICD10CM | Covered |
| S01.131A | ICD10CM | Covered |
| S01.131D | ICD10CM | Covered |
| S01.131S | ICD10CM | Covered |
| S01.132A | ICD10CM | Covered |
| S01.132D | ICD10CM | Covered |
| S01.132S | ICD10CM | Covered |
| S01.141A | ICD10CM | Covered |
| S01.141D | ICD10CM | Covered |
| S01.141S | ICD10CM | Covered |
| S01.142A | ICD10CM | Covered |
| S01.142D | ICD10CM | Covered |
| S01.142S | ICD10CM | Covered |
| S01.151A | ICD10CM | Covered |
| S01.151D | ICD10CM | Covered |
| S01.151S | ICD10CM | Covered |
| S01.152A | ICD10CM | Covered |
| S01.152D | ICD10CM | Covered |
| S01.152S | ICD10CM | Covered |
| S01.20XA | ICD10CM | Covered |
| S01.20XD | ICD10CM | Covered |
| S01.20XS | ICD10CM | Covered |
| S01.21XA | ICD10CM | Covered |
| S01.21XD | ICD10CM | Covered |
| S01.21XS | ICD10CM | Covered |
| S01.22XA | ICD10CM | Covered |
| S01.22XD | ICD10CM | Covered |
| S01.22XS | ICD10CM | Covered |
| S01.23XA | ICD10CM | Covered |
| S01.23XD | ICD10CM | Covered |
| S01.23XS | ICD10CM | Covered |
| S01.24XA | ICD10CM | Covered |
| S01.24XD | ICD10CM | Covered |
| S01.24XS | ICD10CM | Covered |
| S01.25XA | ICD10CM | Covered |
| S01.25XD | ICD10CM | Covered |
| S01.25XS | ICD10CM | Covered |
| S01.301A | ICD10CM | Covered |
| S01.302A | ICD10CM | Covered |
| S01.311A | ICD10CM | Covered |
| S01.311D | ICD10CM | Covered |
| S01.311S | ICD10CM | Covered |
| S01.312A | ICD10CM | Covered |
| S01.312D | ICD10CM | Covered |
| S01.312S | ICD10CM | Covered |
| S01.321A | ICD10CM | Covered |
| S01.321D | ICD10CM | Covered |
| S01.321S | ICD10CM | Covered |
| S01.322A | ICD10CM | Covered |
| S01.322D | ICD10CM | Covered |
| S01.322S | ICD10CM | Covered |
| S01.331A | ICD10CM | Covered |
| S01.331D | ICD10CM | Covered |
| S01.331S | ICD10CM | Covered |
| S01.332A | ICD10CM | Covered |
| S01.332D | ICD10CM | Covered |
| S01.332S | ICD10CM | Covered |
| S01.341A | ICD10CM | Covered |
| S01.341D | ICD10CM | Covered |
| S01.341S | ICD10CM | Covered |
| S01.342A | ICD10CM | Covered |
| S01.342D | ICD10CM | Covered |
| S01.342S | ICD10CM | Covered |
| S01.351A | ICD10CM | Covered |
| S01.351D | ICD10CM | Covered |
| S01.351S | ICD10CM | Covered |
| S01.352A | ICD10CM | Covered |
| S01.352D | ICD10CM | Covered |
| S01.352S | ICD10CM | Covered |
| S01.411A | ICD10CM | Covered |
| S01.411D | ICD10CM | Covered |
| S01.411S | ICD10CM | Covered |
| S01.412A | ICD10CM | Covered |
| S01.412D | ICD10CM | Covered |
| S01.412S | ICD10CM | Covered |
| S01.421A | ICD10CM | Covered |
| S01.421D | ICD10CM | Covered |
| S01.421S | ICD10CM | Covered |
| S01.422A | ICD10CM | Covered |
| S01.422D | ICD10CM | Covered |
| S01.422S | ICD10CM | Covered |
| S01.431A | ICD10CM | Covered |
| S01.431D | ICD10CM | Covered |
| S01.431S | ICD10CM | Covered |
| S01.432A | ICD10CM | Covered |
| S01.432D | ICD10CM | Covered |
| S01.432S | ICD10CM | Covered |
| S01.441A | ICD10CM | Covered |
| S01.441D | ICD10CM | Covered |
| S01.441S | ICD10CM | Covered |
| S01.442A | ICD10CM | Covered |
| S01.442D | ICD10CM | Covered |
| S01.442S | ICD10CM | Covered |
| S01.451A | ICD10CM | Covered |
| S01.451D | ICD10CM | Covered |
| S01.451S | ICD10CM | Covered |
| S01.452A | ICD10CM | Covered |
| S01.452D | ICD10CM | Covered |
| S01.452S | ICD10CM | Covered |
| S01.511A | ICD10CM | Covered |
| S01.511D | ICD10CM | Covered |
| S01.511S | ICD10CM | Covered |
| S01.512A | ICD10CM | Covered |
| S01.512D | ICD10CM | Covered |
| S01.512S | ICD10CM | Covered |
| S01.521A | ICD10CM | Covered |
| S01.521D | ICD10CM | Covered |
| S01.521S | ICD10CM | Covered |
| S01.522A | ICD10CM | Covered |
| S01.522D | ICD10CM | Covered |
| S01.522S | ICD10CM | Covered |
| S01.531A | ICD10CM | Covered |
| S01.531D | ICD10CM | Covered |
| S01.531S | ICD10CM | Covered |
| S01.532A | ICD10CM | Covered |
| S01.532D | ICD10CM | Covered |
| S01.532S | ICD10CM | Covered |
| S01.541A | ICD10CM | Covered |
| S01.541D | ICD10CM | Covered |
| S01.541S | ICD10CM | Covered |
| S01.542A | ICD10CM | Covered |
| S01.542D | ICD10CM | Covered |
| S01.542S | ICD10CM | Covered |
| S01.551A | ICD10CM | Covered |
| S01.551D | ICD10CM | Covered |
| S01.551S | ICD10CM | Covered |
| S01.552A | ICD10CM | Covered |
| S01.552D | ICD10CM | Covered |
| S01.552S | ICD10CM | Covered |
| S01.81XA | ICD10CM | Covered |
| S01.81XD | ICD10CM | Covered |
| S01.81XS | ICD10CM | Covered |
| S01.82XA | ICD10CM | Covered |
| S01.82XD | ICD10CM | Covered |
| S01.82XS | ICD10CM | Covered |
| S01.83XA | ICD10CM | Covered |
| S01.83XD | ICD10CM | Covered |
| S01.83XS | ICD10CM | Covered |
| S01.84XA | ICD10CM | Covered |
| S01.84XD | ICD10CM | Covered |
| S01.84XS | ICD10CM | Covered |
| S01.85XA | ICD10CM | Covered |
| S01.85XD | ICD10CM | Covered |
| S01.85XS | ICD10CM | Covered |
| S01.91XA | ICD10CM | Covered |
| S01.91XD | ICD10CM | Covered |
| S01.92XA | ICD10CM | Covered |
| S01.93XA | ICD10CM | Covered |
| S01.94XA | ICD10CM | Covered |
| S01.95XA | ICD10CM | Covered |
| S02.5XXA | ICD10CM | Covered |
| S02.5XXB | ICD10CM | Covered |
| S03.2XXA | ICD10CM | Covered |
| S03.2XXD | ICD10CM | Covered |
| S03.2XXS | ICD10CM | Covered |
| S05.01XA | ICD10CM | Covered |
| S05.01XD | ICD10CM | Covered |
| S05.01XS | ICD10CM | Covered |
| S05.02XA | ICD10CM | Covered |
| S05.02XD | ICD10CM | Covered |
| S05.02XS | ICD10CM | Covered |
| S05.11XA | ICD10CM | Covered |
| S05.11XD | ICD10CM | Covered |
| S05.11XS | ICD10CM | Covered |
| S05.12XA | ICD10CM | Covered |
| S05.12XD | ICD10CM | Covered |
| S05.12XS | ICD10CM | Covered |
| S05.21XA | ICD10CM | Covered |
| S05.21XD | ICD10CM | Covered |
| S05.21XS | ICD10CM | Covered |
| S05.22XA | ICD10CM | Covered |
| S05.22XD | ICD10CM | Covered |
| S05.22XS | ICD10CM | Covered |
| S05.31XA | ICD10CM | Covered |
| S05.31XD | ICD10CM | Covered |
| S05.31XS | ICD10CM | Covered |
| S05.32XA | ICD10CM | Covered |
| S05.32XD | ICD10CM | Covered |
| S05.32XS | ICD10CM | Covered |
| S05.41XA | ICD10CM | Covered |
| S05.41XD | ICD10CM | Covered |
| S05.41XS | ICD10CM | Covered |
| S05.42XA | ICD10CM | Covered |
| S05.42XD | ICD10CM | Covered |
| S05.42XS | ICD10CM | Covered |
| S05.51XA | ICD10CM | Covered |
| S05.51XD | ICD10CM | Covered |
| S05.51XS | ICD10CM | Covered |
| S05.52XA | ICD10CM | Covered |
| S05.52XD | ICD10CM | Covered |
| S05.52XS | ICD10CM | Covered |
| S05.61XA | ICD10CM | Covered |
| S05.61XD | ICD10CM | Covered |
| S05.61XS | ICD10CM | Covered |
| S05.62XA | ICD10CM | Covered |
| S05.62XD | ICD10CM | Covered |
| S05.62XS | ICD10CM | Covered |
| S05.71XA | ICD10CM | Covered |
| S05.72XA | ICD10CM | Covered |
| S05.8X1A | ICD10CM | Covered |
| S05.8X2A | ICD10CM | Covered |
| S07.0XXA | ICD10CM | Covered |
| S07.0XXD | ICD10CM | Covered |
| S07.0XXS | ICD10CM | Covered |
| S07.1XXA | ICD10CM | Covered |
| S07.1XXD | ICD10CM | Covered |
| S07.1XXS | ICD10CM | Covered |
| S07.8XXA | ICD10CM | Covered |
| S07.8XXD | ICD10CM | Covered |
| S07.8XXS | ICD10CM | Covered |
| S08.0XXA | ICD10CM | Covered |
| S08.0XXD | ICD10CM | Covered |
| S08.0XXS | ICD10CM | Covered |
| S08.111A | ICD10CM | Covered |
| S08.111D | ICD10CM | Covered |
| S08.111S | ICD10CM | Covered |
| S08.112A | ICD10CM | Covered |
| S08.112D | ICD10CM | Covered |
| S08.112S | ICD10CM | Covered |
| S08.121A | ICD10CM | Covered |
| S08.121D | ICD10CM | Covered |
| S08.121S | ICD10CM | Covered |
| S08.122A | ICD10CM | Covered |
| S08.122D | ICD10CM | Covered |
| S08.122S | ICD10CM | Covered |
| S08.811A | ICD10CM | Covered |
| S08.811D | ICD10CM | Covered |
| S08.811S | ICD10CM | Covered |
| S08.812A | ICD10CM | Covered |
| S08.812D | ICD10CM | Covered |
| S08.812S | ICD10CM | Covered |
| S08.89XA | ICD10CM | Covered |
| S08.89XD | ICD10CM | Covered |
| S08.89XS | ICD10CM | Covered |
| S09.12XA | ICD10CM | Covered |
| S09.12XD | ICD10CM | Covered |
| S09.12XS | ICD10CM | Covered |
| S09.21XA | ICD10CM | Covered |
| S09.21XD | ICD10CM | Covered |
| S09.21XS | ICD10CM | Covered |
| S09.22XA | ICD10CM | Covered |
| S09.22XD | ICD10CM | Covered |
| S09.22XS | ICD10CM | Covered |
| S09.311A | ICD10CM | Covered |
| S09.311D | ICD10CM | Covered |
| S09.311S | ICD10CM | Covered |
| S09.312A | ICD10CM | Covered |
| S09.312D | ICD10CM | Covered |
| S09.312S | ICD10CM | Covered |
| S09.313A | ICD10CM | Covered |
| S09.313D | ICD10CM | Covered |
| S09.313S | ICD10CM | Covered |
| S09.391A | ICD10CM | Covered |
| S09.392A | ICD10CM | Covered |
| S09.8XXA | ICD10CM | Covered |
| S09.91XA | ICD10CM | Covered |
| S09.93XA | ICD10CM | Covered |
| S10.0XXA | ICD10CM | Covered |