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 1,200 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 76376 | CPT | Covered |
| 76377 | CPT | Covered |
| 93303 | CPT | Covered |
| 93304 | CPT | Covered |
| 93306 | CPT | Covered |
| 93307 | CPT | Covered |
| 93308 | CPT | Covered |
| 93320 | CPT | Covered |
| 93321 | CPT | Covered |
| 93325 | CPT | Covered |
| 93350 | CPT | Covered |
| 93351 | CPT | Covered |
| 93352 | CPT | Covered |
| A9700 | HCPCS | Covered |
| C8921 | HCPCS | Covered |
| C8922 | HCPCS | Covered |
| C8923 | HCPCS | Covered |
| C8924 | HCPCS | Covered |
| C8928 | HCPCS | Covered |
| C8929 | HCPCS | Covered |
| C8930 | HCPCS | Covered |
| C9399 | HCPCS | Covered |
| J0153 | HCPCS | Covered |
| J0280 | HCPCS | Covered |
| J0461 | HCPCS | Covered |
| J1245 | HCPCS | Covered |
| J1250 | HCPCS | Covered |
| J2785 | HCPCS | Covered |
| J3490 | HCPCS | Covered |
| Q9955 | HCPCS | Covered |
| Q9956 | HCPCS | Covered |
| Q9957 | HCPCS | Covered |
| A18.84 | ICD10CM | Covered |
| A36.81 | ICD10CM | Covered |
| A39.53 | ICD10CM | Covered |
| A40.0 | ICD10CM | Covered |
| A40.1 | ICD10CM | Covered |
| A40.3 | ICD10CM | Covered |
| A40.8 | 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 |
| A41.59 | ICD10CM | Covered |
| A41.81 | ICD10CM | Covered |
| A41.89 | ICD10CM | Covered |
| A41.9 | ICD10CM | Covered |
| A42.7 | ICD10CM | Covered |
| A52.01 | ICD10CM | Covered |
| A52.02 | ICD10CM | Covered |
| A52.03 | ICD10CM | Covered |
| A52.06 | ICD10CM | Covered |
| A54.83 | ICD10CM | Covered |
| A69.21 | ICD10CM | Covered |
| A69.22 | ICD10CM | Covered |
| A69.23 | ICD10CM | Covered |
| A69.29 | ICD10CM | Covered |
| B33.20 | ICD10CM | Covered |
| B33.21 | ICD10CM | Covered |
| B33.22 | ICD10CM | Covered |
| B33.23 | ICD10CM | Covered |
| B37.6 | ICD10CM | Covered |
| B39.4 | ICD10CM | Covered |
| B39.5 | ICD10CM | Covered |
| B57.0 | ICD10CM | Covered |
| B57.2 | ICD10CM | Covered |
| B58.81 | ICD10CM | Covered |
| C38.0 | ICD10CM | Covered |
| C45.2 | ICD10CM | Covered |
| C79.89 | ICD10CM | Covered |
| D15.1 | ICD10CM | Covered |
| D48.7 | ICD10CM | Covered |
| D49.89 | ICD10CM | Covered |
| D82.1 | 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 |
| E03.5 | ICD10CM | Covered |
| E83.110 | ICD10CM | Covered |
| E83.111 | ICD10CM | Covered |
| E83.118 | ICD10CM | Covered |
| E83.19 | 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 |
| G06.0 | ICD10CM | Covered |
| G06.1 | ICD10CM | Covered |
| G45.0 | ICD10CM | Covered |
| G45.1 | ICD10CM | Covered |
| G45.2 | ICD10CM | Covered |
| G45.3 | ICD10CM | Covered |
| G45.8 | ICD10CM | Covered |
| G45.9 | ICD10CM | Covered |
| G46.0 | ICD10CM | Covered |
| G46.1 | ICD10CM | Covered |
| G46.2 | ICD10CM | Covered |
| G47.30 | ICD10CM | Covered |
| G47.31 | ICD10CM | Covered |
| G47.32 | ICD10CM | Covered |
| G47.33 | ICD10CM | Covered |
| H34.01 | ICD10CM | Covered |
| H34.02 | ICD10CM | Covered |
| H34.03 | 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 |
| I06.0 | ICD10CM | Covered |
| I06.1 | ICD10CM | Covered |
| I06.2 | ICD10CM | Covered |
| I06.8 | 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 |
| 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 |
| I20.81 | ICD10CM | Covered |
| I20.89 | 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.A1 | ICD10CM | Covered |
| I21.A9 | ICD10CM | Covered |
| I22.0 | ICD10CM | Covered |
| I22.1 | ICD10CM | Covered |
| I22.2 | ICD10CM | Covered |
| I22.8 | ICD10CM | Covered |
| I22.9 | 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 |
| I24.81 | ICD10CM | Covered |
| I24.89 | ICD10CM | Covered |
| I25.10 | ICD10CM | Covered |
| I25.110 | ICD10CM | Covered |
| I25.111 | ICD10CM | Covered |
| I25.112 | ICD10CM | Covered |
| I25.118 | 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 |
| I25.702 | ICD10CM | Covered |
| I25.710 | ICD10CM | Covered |
| I25.711 | ICD10CM | Covered |
| I25.712 | ICD10CM | Covered |
| I25.718 | ICD10CM | Covered |
| I25.720 | ICD10CM | Covered |
| I25.721 | ICD10CM | Covered |
| I25.722 | ICD10CM | Covered |
| I25.728 | ICD10CM | Covered |
| I25.730 | ICD10CM | Covered |
| I25.731 | ICD10CM | Covered |
| I25.732 | ICD10CM | Covered |
| I25.738 | ICD10CM | Covered |
| I25.750 | ICD10CM | Covered |
| I25.751 | ICD10CM | Covered |
| I25.752 | ICD10CM | Covered |
| I25.758 | ICD10CM | Covered |
| I25.760 | ICD10CM | Covered |
| I25.761 | ICD10CM | Covered |
| I25.762 | ICD10CM | Covered |
| I25.768 | ICD10CM | Covered |
| I25.790 | ICD10CM | Covered |
| I25.791 | ICD10CM | Covered |
| I25.792 | ICD10CM | Covered |
| I25.798 | ICD10CM | Covered |
| I25.810 | ICD10CM | Covered |
| I25.811 | ICD10CM | Covered |
| I25.812 | ICD10CM | Covered |
| I25.82 | ICD10CM | Covered |
| I25.84 | 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 |
| I26.90 | 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 |
| I27.82 | ICD10CM | Covered |
| I27.83 | ICD10CM | Covered |
| I27.840 | ICD10CM | Covered |
| I27.841 | ICD10CM | Covered |
| I27.848 | ICD10CM | Covered |
| I27.89 | ICD10CM | Covered |
| I28.0 | ICD10CM | Covered |
| I28.1 | ICD10CM | Covered |
| I30.0 | ICD10CM | Covered |
| I30.1 | ICD10CM | Covered |
| I30.8 | ICD10CM | Covered |
| I31.0 | ICD10CM | Covered |
| I31.1 | ICD10CM | Covered |
| I31.2 | ICD10CM | Covered |
| I31.31 | ICD10CM | Covered |
| I31.39 | ICD10CM | Covered |
| I31.4 | 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 |
| I38 | ICD10CM | Covered |
| I39 | ICD10CM | Covered |
| I40.0 | ICD10CM | Covered |
| I40.1 | ICD10CM | Covered |
| I40.8 | ICD10CM | Covered |
| I40.9 | ICD10CM | Covered |
| I41 | ICD10CM | Covered |
| I42.0 | 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 |
| I42.8 | ICD10CM | Covered |
| I43 | 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 |
| I45.9 | ICD10CM | Covered |
| I46.2 | ICD10CM | Covered |
| I46.8 | ICD10CM | Covered |
| I46.9 | ICD10CM | Covered |
| I47.0 | ICD10CM | Covered |
| I47.11 | ICD10CM | Covered |
| I47.19 | ICD10CM | Covered |
| I47.21 | 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 |
| 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 |
| I50.1 | ICD10CM | Covered |
| I50.20 | ICD10CM | Covered |
| I50.21 | ICD10CM | Covered |
| I50.22 | ICD10CM | Covered |
| I50.23 | ICD10CM | Covered |
| I50.30 | ICD10CM | Covered |
| I50.31 | ICD10CM | Covered |
| I50.32 | ICD10CM | Covered |
| I50.33 | ICD10CM | Covered |
| I50.40 | ICD10CM | Covered |
| I50.41 | ICD10CM | Covered |
| I50.42 | ICD10CM | Covered |
| I50.43 | ICD10CM | Covered |
| I50.9 | ICD10CM | Covered |
| I51.0 | ICD10CM | Covered |
| I51.1 | ICD10CM | Covered |
| I51.2 | ICD10CM | Covered |
| I51.3 | ICD10CM | Covered |
| I51.4 | ICD10CM | Covered |
| I51.5 | ICD10CM | Covered |
| I51.7 | ICD10CM | Covered |
| I51.81 | ICD10CM | Covered |
| I51.89 | ICD10CM | Covered |
| I51.9 | ICD10CM | Covered |
| I52 | ICD10CM | Covered |
| I60.01 | ICD10CM | Covered |
| I60.02 | ICD10CM | Covered |
| I60.11 | ICD10CM | Covered |
| I60.12 | ICD10CM | Covered |
| I60.31 | ICD10CM | Covered |
| I60.32 | ICD10CM | Covered |
| I60.4 | ICD10CM | Covered |
| I60.51 | ICD10CM | Covered |
| I60.52 | ICD10CM | Covered |
| I60.6 | ICD10CM | Covered |
| I60.7 | ICD10CM | Covered |
| I60.8 | ICD10CM | Covered |
| I63.311 | ICD10CM | Covered |
| I63.312 | ICD10CM | Covered |
| I63.321 | ICD10CM | Covered |
| I63.322 | ICD10CM | Covered |
| I63.331 | ICD10CM | Covered |
| I63.332 | ICD10CM | Covered |
| I63.341 | ICD10CM | Covered |
| I63.342 | ICD10CM | Covered |
| I63.39 | ICD10CM | Covered |
| I63.411 | ICD10CM | Covered |
| I63.412 | ICD10CM | Covered |
| I63.421 | ICD10CM | Covered |
| I63.422 | ICD10CM | Covered |
| I63.431 | ICD10CM | Covered |
| I63.432 | ICD10CM | Covered |
| I63.441 | ICD10CM | Covered |
| I63.442 | ICD10CM | Covered |
| I63.49 | ICD10CM | Covered |
| I63.511 | ICD10CM | Covered |
| I63.512 | ICD10CM | Covered |
| I63.521 | ICD10CM | Covered |
| I63.522 | ICD10CM | Covered |
| I63.531 | ICD10CM | Covered |
| I63.532 | ICD10CM | Covered |
| I63.541 | ICD10CM | Covered |
| I63.542 | ICD10CM | Covered |
| I63.59 | ICD10CM | Covered |
| I63.6 | ICD10CM | Covered |
| I63.81 | ICD10CM | Covered |
| I63.89 | 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 |
| I67.841 | ICD10CM | Covered |
| I67.848 | ICD10CM | Covered |
| I67.850 | ICD10CM | Covered |
| I67.858 | ICD10CM | Covered |
| I67.89 | ICD10CM | Covered |
| I70.0 | ICD10CM | Covered |
| I71.00 | 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 |
| I71.11 | ICD10CM | Covered |
| I71.12 | ICD10CM | Covered |
| I71.13 | ICD10CM | Covered |
| I71.21 | ICD10CM | Covered |
| I71.22 | ICD10CM | Covered |
| I71.23 | 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 |
| I71.51 | ICD10CM | Covered |
| I71.52 | ICD10CM | Covered |
| I71.61 | ICD10CM | Covered |
| I71.62 | ICD10CM | Covered |
| I71.8 | ICD10CM | Covered |
| I74.11 | ICD10CM | Covered |
| I74.2 | ICD10CM | Covered |
| I74.3 | ICD10CM | Covered |
| I74.4 | ICD10CM | Covered |
| I74.5 | ICD10CM | Covered |
| I74.8 | ICD10CM | Covered |
| I74.9 | ICD10CM | Covered |
| I76 | ICD10CM | Covered |
| I77.810 | ICD10CM | Covered |
| I79.0 | ICD10CM | Covered |
| I95.1 | ICD10CM | Covered |
| I95.2 | ICD10CM | Covered |
| I95.81 | ICD10CM | Covered |
| I95.89 | ICD10CM | Covered |
| I95.9 | 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 |
| I97.710 | ICD10CM | Covered |
| I97.711 | ICD10CM | Covered |
| I97.790 | ICD10CM | Covered |
| I97.791 | ICD10CM | Covered |
| I97.88 | ICD10CM | Covered |
| I97.89 | ICD10CM | Covered |
| J80 | ICD10CM | Covered |
| J81.0 | ICD10CM | Covered |
| J95.1 | ICD10CM | Covered |
| J95.2 | ICD10CM | Covered |
| J95.3 | ICD10CM | Covered |
| J95.821 | ICD10CM | Covered |
| J95.822 | ICD10CM | Covered |
| J95.84 | ICD10CM | Covered |
| J96.01 | ICD10CM | Covered |
| J96.02 | ICD10CM | Covered |
| J96.21 | ICD10CM | Covered |
| J96.22 | ICD10CM | Covered |
| K68.11 | ICD10CM | Covered |
| M30.3 | ICD10CM | Covered |
| M31.4 | 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 |
| M32.9 | ICD10CM | Covered |
| N26.2 | ICD10CM | Covered |
| N98.0 | ICD10CM | Covered |
| O90.3 | ICD10CM | Covered |
| O90.89 | ICD10CM | Covered |
| P22.8 | ICD10CM | Covered |
| P22.9 | ICD10CM | Covered |
| P28.31 | ICD10CM | Covered |
| P28.32 | ICD10CM | Covered |
| P28.33 | ICD10CM | Covered |
| P28.39 | ICD10CM | Covered |
| P28.41 | ICD10CM | Covered |
| P28.42 | ICD10CM | Covered |
| P28.43 | ICD10CM | Covered |
| P28.49 | ICD10CM | Covered |
| P28.89 | ICD10CM | Covered |
| P29.0 | ICD10CM | Covered |
| P29.11 | ICD10CM | Covered |
| P29.12 | ICD10CM | Covered |
| P29.2 | ICD10CM | Covered |
| P29.30 | ICD10CM | Covered |
| P29.38 | ICD10CM | Covered |
| P29.4 | ICD10CM | Covered |
| P29.89 | ICD10CM | Covered |
| P94.1 | ICD10CM | Covered |
| P94.2 | ICD10CM | Covered |
| P94.8 | ICD10CM | Covered |
| P96.0 | ICD10CM | Covered |
| P96.3 | ICD10CM | Covered |
| P96.5 | ICD10CM | Covered |
| P96.89 | ICD10CM | Covered |
| Q20.0 | ICD10CM | Covered |
| Q20.1 | ICD10CM | Covered |
| Q20.2 | ICD10CM | Covered |
| Q20.3 | ICD10CM | Covered |
| Q20.4 | ICD10CM | Covered |
| Q20.5 | ICD10CM | Covered |
| Q20.6 | ICD10CM | Covered |
| Q20.8 | ICD10CM | Covered |
| Q21.0 | ICD10CM | Covered |
| Q21.10 | ICD10CM | Covered |
| Q21.11 | ICD10CM | Covered |
| Q21.12 | ICD10CM | Covered |
| Q21.13 | ICD10CM | Covered |
| Q21.14 | ICD10CM | Covered |
| Q21.15 | ICD10CM | Covered |
| Q21.16 | ICD10CM | Covered |
| Q21.19 | ICD10CM | Covered |
| Q21.20 | ICD10CM | Covered |
| Q21.21 | ICD10CM | Covered |
| Q21.22 | ICD10CM | Covered |
| Q21.23 | ICD10CM | Covered |
| Q21.3 | ICD10CM | Covered |
| Q21.4 | ICD10CM | Covered |
| Q21.8 | ICD10CM | Covered |
| Q21.9 | ICD10CM | Covered |
| Q22.0 | ICD10CM | Covered |
| Q22.1 | ICD10CM | Covered |
| Q22.2 | ICD10CM | Covered |
| Q22.3 | ICD10CM | Covered |
| Q22.4 | ICD10CM | Covered |
| Q22.5 | ICD10CM | Covered |
| Q22.6 | ICD10CM | Covered |
| Q22.8 | ICD10CM | Covered |
| Q23.0 | ICD10CM | Covered |
| Q23.1 | ICD10CM | Covered |
| Q23.2 | ICD10CM | Covered |
| Q23.3 | ICD10CM | Covered |
| Q23.4 | ICD10CM | Covered |
| Q23.81 | ICD10CM | Covered |
| Q23.82 | ICD10CM | Covered |
| Q23.88 | ICD10CM | Covered |
| Q24.0 | ICD10CM | Covered |
| Q24.1 | ICD10CM | Covered |
| Q24.2 | ICD10CM | Covered |
| Q24.3 | ICD10CM | Covered |
| Q24.4 | ICD10CM | Covered |
| Q24.5 | ICD10CM | Covered |
| Q24.6 | ICD10CM | Covered |
| Q24.8 | ICD10CM | Covered |
| Q25.0 | ICD10CM | Covered |
| Q25.1 | ICD10CM | Covered |
| Q25.21 | ICD10CM | Covered |
| Q25.29 | ICD10CM | Covered |
| Q25.3 | ICD10CM | Covered |
| Q25.41 | ICD10CM | Covered |
| Q25.42 | ICD10CM | Covered |
| Q25.43 | ICD10CM | Covered |
| Q25.44 | ICD10CM | Covered |
| Q25.45 | ICD10CM | Covered |
| Q25.46 | ICD10CM | Covered |
| Q25.47 | ICD10CM | Covered |
| Q25.48 | ICD10CM | Covered |
| Q25.49 | ICD10CM | Covered |
| Q25.5 | ICD10CM | Covered |
| Q25.6 | ICD10CM | Covered |
| Q25.71 | ICD10CM | Covered |
| Q25.72 | ICD10CM | Covered |
| Q25.79 | ICD10CM | Covered |
| Q25.8 | ICD10CM | Covered |
| Q26.0 | ICD10CM | Covered |
| Q26.1 | ICD10CM | Covered |
| Q26.2 | ICD10CM | Covered |
| Q26.3 | ICD10CM | Covered |
| Q26.4 | ICD10CM | Covered |
| Q26.8 | ICD10CM | Covered |
| Q26.9 | ICD10CM | Covered |
| Q27.0 | ICD10CM | Covered |
| Q27.9 | ICD10CM | Covered |
| Q28.2 | ICD10CM | Covered |
| Q28.3 | ICD10CM | Covered |
| Q28.9 | ICD10CM | Covered |
| Q30.0 | ICD10CM | Covered |
| Q33.2 | ICD10CM | Covered |
| Q33.3 | ICD10CM | Covered |
| Q33.6 | ICD10CM | Covered |
| Q40.1 | ICD10CM | Covered |
| Q67.6 | ICD10CM | Covered |
| Q67.7 | ICD10CM | Covered |
| Q87.410 | ICD10CM | Covered |
| Q87.418 | ICD10CM | Covered |
| Q87.42 | ICD10CM | Covered |
| Q87.43 | ICD10CM | Covered |
| Q89.01 | ICD10CM | Covered |
| Q89.09 | ICD10CM | Covered |
| Q89.3 | ICD10CM | Covered |
| Q89.7 | ICD10CM | Covered |
| Q89.9 | ICD10CM | Covered |
| Q90.0 | ICD10CM | Covered |
| Q90.1 | ICD10CM | Covered |
| Q90.2 | ICD10CM | Covered |
| Q91.0 | ICD10CM | Covered |
| Q91.1 | ICD10CM | Covered |
| Q91.2 | ICD10CM | Covered |
| Q91.3 | ICD10CM | Covered |
| Q91.4 | ICD10CM | Covered |
| Q91.5 | ICD10CM | Covered |
| Q91.6 | ICD10CM | Covered |
| Q96.0 | ICD10CM | Covered |
| Q96.1 | ICD10CM | Covered |
| Q96.2 | ICD10CM | Covered |
| Q96.3 | ICD10CM | Covered |
| Q96.4 | ICD10CM | Covered |
| Q96.8 | ICD10CM | Covered |
| R00.2 | ICD10CM | Covered |
| R00.8 | ICD10CM | Covered |
| R01.0 | ICD10CM | Covered |
| R01.1 | ICD10CM | Covered |
| R01.2 | ICD10CM | Covered |
| R06.00 | ICD10CM | Covered |
| R06.01 | ICD10CM | Covered |
| R06.02 | ICD10CM | Covered |
| R06.09 | ICD10CM | Covered |
| R06.2 | ICD10CM | Covered |
| R06.3 | ICD10CM | Covered |
| R06.81 | ICD10CM | Covered |
| R06.82 | ICD10CM | Covered |
| R06.83 | ICD10CM | Covered |
| R06.89 | ICD10CM | Covered |
| R07.2 | ICD10CM | Covered |
| R07.82 | ICD10CM | Covered |
| R07.89 | ICD10CM | Covered |
| R07.9 | ICD10CM | Covered |
| R09.2 | ICD10CM | Covered |
| R22.2 | ICD10CM | Covered |
| R23.0 | ICD10CM | Covered |
| R40.20 | ICD10CM | Covered |
| R40.2111 | ICD10CM | Covered |
| R40.2112 | ICD10CM | Covered |
| R40.2113 | ICD10CM | Covered |
| R40.2114 | ICD10CM | Covered |
| R40.2121 | ICD10CM | Covered |
| R40.2122 | ICD10CM | Covered |
| R40.2123 | ICD10CM | Covered |
| R40.2124 | ICD10CM | Covered |
| R40.2211 | ICD10CM | Covered |
| R40.2212 | ICD10CM | Covered |
| R40.2213 | ICD10CM | Covered |
| R40.2214 | ICD10CM | Covered |
| R40.2221 | ICD10CM | Covered |
| R40.2222 | ICD10CM | Covered |
| R40.2223 | ICD10CM | Covered |
| R40.2224 | ICD10CM | Covered |
| R40.2311 | ICD10CM | Covered |
| R40.2312 | ICD10CM | Covered |
| R40.2313 | ICD10CM | Covered |
| R40.2314 | ICD10CM | Covered |
| R40.2321 | ICD10CM | Covered |
| R40.2322 | ICD10CM | Covered |
| R40.2323 | ICD10CM | Covered |
| R40.2324 | ICD10CM | Covered |
| R40.2341 | ICD10CM | Covered |
| R40.2342 | ICD10CM | Covered |
| R40.2343 | ICD10CM | Covered |
| R40.2344 | ICD10CM | Covered |
| R40.4 | ICD10CM | Covered |
| R47.01 | ICD10CM | Covered |
| R50.2 | ICD10CM | Covered |
| R50.81 | ICD10CM | Covered |
| R50.82 | ICD10CM | Covered |
| R50.9 | ICD10CM | Covered |
| R55 | ICD10CM | Covered |
| R57.0 | ICD10CM | Covered |
| R57.1 | ICD10CM | Covered |
| R57.8 | ICD10CM | Covered |
| R57.9 | ICD10CM | Covered |
| R60.0 | ICD10CM | Covered |
| R60.1 | ICD10CM | Covered |
| R65.21 | ICD10CM | Covered |
| R68.89 | ICD10CM | Covered |
| R78.81 | ICD10CM | Covered |
| R94.31 | ICD10CM | Covered |
| S12.000B | ICD10CM | Covered |
| S12.001B | ICD10CM | Covered |
| S12.100B | ICD10CM | Covered |
| S12.101B | ICD10CM | Covered |
| S12.200B | ICD10CM | Covered |
| S12.201B | ICD10CM | Covered |
| S12.300B | ICD10CM | Covered |
| S12.301B | ICD10CM | Covered |
| S14.111A | ICD10CM | Covered |
| S14.112A | ICD10CM | Covered |
| S14.113A | ICD10CM | Covered |
| S14.114A | ICD10CM | Covered |
| S14.121A | ICD10CM | Covered |
| S14.122A | ICD10CM | Covered |
| S14.123A | ICD10CM | Covered |
| S14.124A | ICD10CM | Covered |
| S21.309A | ICD10CM | Covered |
| S22.5XXA | ICD10CM | Covered |
| S22.5XXB | ICD10CM | Covered |
| S25.01XA | ICD10CM | Covered |
| S25.02XA | ICD10CM | Covered |
| S25.09XA | ICD10CM | Covered |
| S25.21XA | ICD10CM | Covered |
| S25.22XA | ICD10CM | Covered |
| S25.29XA | ICD10CM | Covered |
| S25.401A | ICD10CM | Covered |
| S25.402A | ICD10CM | Covered |
| S25.411A | ICD10CM | Covered |
| S25.412A | ICD10CM | Covered |
| S25.421A | ICD10CM | Covered |
| S25.422A | ICD10CM | Covered |
| S25.491A | ICD10CM | Covered |
| S25.492A | ICD10CM | Covered |
| S26.00XA | ICD10CM | Covered |
| S26.01XA | ICD10CM | Covered |
| S26.020A | ICD10CM | Covered |
| S26.021A | ICD10CM | Covered |
| S26.022A | ICD10CM | Covered |
| S26.09XA | ICD10CM | Covered |
| S26.10XA | ICD10CM | Covered |
| S26.11XA | ICD10CM | Covered |
| S26.12XA | ICD10CM | Covered |
| S26.19XA | ICD10CM | Covered |
| S26.90XA | ICD10CM | Covered |
| S26.92XA | ICD10CM | Covered |
| S29.091A | ICD10CM | Covered |
| S29.092A | ICD10CM | Covered |
| S29.8XXA | ICD10CM | Covered |
| T36.0X5A | ICD10CM | Covered |
| T36.1X5A | ICD10CM | Covered |
| T36.2X5A | ICD10CM | Covered |
| T36.3X5A | ICD10CM | Covered |
| T36.4X5A | ICD10CM | Covered |
| T36.5X5A | ICD10CM | Covered |
| T36.6X5A | ICD10CM | Covered |
| T36.7X5A | ICD10CM | Covered |
| T36.8X5A | ICD10CM | Covered |
| T37.0X5A | ICD10CM | Covered |
| T37.1X5A | ICD10CM | Covered |
| T37.2X5A | ICD10CM | Covered |
| T37.3X5A | ICD10CM | Covered |
| T37.4X5A | ICD10CM | Covered |
| T37.5X5A | ICD10CM | Covered |
| T37.8X5A | ICD10CM | Covered |
| T38.0X1A | ICD10CM | Covered |
| T38.0X2A | ICD10CM | Covered |
| T38.0X3A | ICD10CM | Covered |
| T38.0X5A | ICD10CM | Covered |
| T38.1X5A | ICD10CM | Covered |
| T38.2X5A | ICD10CM | Covered |
| T38.4X5A | ICD10CM | Covered |
| T38.5X5A | ICD10CM | Covered |
| T38.6X5A | ICD10CM | Covered |
| T38.7X5A | ICD10CM | Covered |
| T38.815A | ICD10CM | Covered |
| T38.895A | ICD10CM | Covered |
| T38.995A | ICD10CM | Covered |
| T39.015A | ICD10CM | Covered |
| T39.095A | ICD10CM | Covered |
| T39.1X5A | ICD10CM | Covered |
| T39.2X5A | ICD10CM | Covered |
| T39.315A | ICD10CM | Covered |
| T39.395A | ICD10CM | Covered |
| T39.4X5A | ICD10CM | Covered |
| T39.8X5A | ICD10CM | Covered |
| T40.0X5A | ICD10CM | Covered |
| T40.2X1A | ICD10CM | Covered |
| T40.2X3A | ICD10CM | Covered |
| T40.2X4A | ICD10CM | Covered |
| T40.2X5A | ICD10CM | Covered |
| T40.3X5A | ICD10CM | Covered |
| T40.491A | ICD10CM | Covered |
| T40.492A | ICD10CM | Covered |
| T40.493A | ICD10CM | Covered |
| T40.495A | ICD10CM | Covered |
| T40.5X5A | ICD10CM | Covered |
| T40.691A | ICD10CM | Covered |
| T40.692A | ICD10CM | Covered |
| T40.693A | ICD10CM | Covered |
| T40.695A | ICD10CM | Covered |
| T40.715A | ICD10CM | Covered |
| T40.725A | ICD10CM | Covered |
| T40.995A | ICD10CM | Covered |
| T41.0X5A | ICD10CM | Covered |
| T41.1X5A | ICD10CM | Covered |
| T41.295A | ICD10CM | Covered |
| T41.3X5A | ICD10CM | Covered |
| T41.5X5A | ICD10CM | Covered |
| T42.0X5A | ICD10CM | Covered |
| T42.1X5A | ICD10CM | Covered |
| T42.2X5A | ICD10CM | Covered |
| T42.3X5A | ICD10CM | Covered |
| T42.4X5A | ICD10CM | Covered |
| T42.5X5A | ICD10CM | Covered |
| T42.6X5A | ICD10CM | Covered |
| T42.8X5A | ICD10CM | Covered |
| T43.015A | ICD10CM | Covered |
| T43.025A | ICD10CM | Covered |
| T43.1X5A | ICD10CM | Covered |
| T43.215A | ICD10CM | Covered |
| T43.225A | ICD10CM | Covered |
| T43.295A | ICD10CM | Covered |
| T43.3X5A | ICD10CM | Covered |
| T43.4X5A | ICD10CM | Covered |
| T43.595A | ICD10CM | Covered |
| T43.615A | ICD10CM | Covered |
| T43.625A | ICD10CM | Covered |
| T43.635A | ICD10CM | Covered |
| T43.641A | ICD10CM | Covered |
| T43.641D | ICD10CM | Covered |
| T43.641S | ICD10CM | Covered |
| T43.642A | ICD10CM | Covered |
| T43.642D | ICD10CM | Covered |
| T43.642S | ICD10CM | Covered |
| T43.643A | ICD10CM | Covered |
| T43.643D | ICD10CM | Covered |
| T43.643S | ICD10CM | Covered |
| T43.644A | ICD10CM | Covered |
| T43.644D | ICD10CM | Covered |
| T43.644S | ICD10CM | Covered |
| T43.651A | ICD10CM | Covered |
| T43.651D | ICD10CM | Covered |
| T43.651S | ICD10CM | Covered |
| T43.652A | ICD10CM | Covered |
| T43.652D | ICD10CM | Covered |
| T43.652S | ICD10CM | Covered |
| T43.653A | ICD10CM | Covered |
| T43.653D | ICD10CM | Covered |
| T43.653S | ICD10CM | Covered |
| T43.654A | ICD10CM | Covered |
| T43.654D | ICD10CM | Covered |
| T43.654S | ICD10CM | Covered |
| T43.655A | ICD10CM | Covered |
| T43.655D | ICD10CM | Covered |
| T43.655S | ICD10CM | Covered |
| T43.656A | ICD10CM | Covered |
| T43.656D | ICD10CM | Covered |
| T43.656S | ICD10CM | Covered |
| T43.695A | ICD10CM | Covered |
| T43.8X5A | ICD10CM | Covered |
| T44.0X5A | ICD10CM | Covered |
| T44.1X5A | ICD10CM | Covered |
| T44.2X1A | ICD10CM | Covered |
| T44.2X2A | ICD10CM | Covered |
| T44.2X3A | ICD10CM | Covered |
| T44.2X5A | ICD10CM | Covered |
| T44.3X5A | ICD10CM | Covered |
| T44.4X5A | ICD10CM | Covered |
| T44.5X5A | ICD10CM | Covered |
| T44.6X5A | ICD10CM | Covered |
| T44.7X5A | ICD10CM | Covered |
| T44.8X5A | ICD10CM | Covered |
| T44.995A | ICD10CM | Covered |
| T45.0X1A | ICD10CM | Covered |
| T45.0X2A | ICD10CM | Covered |
| T45.0X3A | ICD10CM | Covered |
| T45.0X5A | ICD10CM | Covered |
| T45.1X1A | ICD10CM | Covered |
| T45.1X2A | ICD10CM | Covered |
| T45.1X3A | ICD10CM | Covered |
| T45.1X5A | ICD10CM | Covered |
| T45.1X5S | ICD10CM | Covered |
| T45.2X5A | ICD10CM | Covered |
| T45.3X5A | ICD10CM | Covered |
| T45.4X5A | ICD10CM | Covered |
| T45.515A | ICD10CM | Covered |
| T45.525A | ICD10CM | Covered |
| T45.615A | ICD10CM | Covered |
| T45.625A | ICD10CM | Covered |
| T45.695A | ICD10CM | Covered |
| T45.7X5A | ICD10CM | Covered |
| T45.8X5A | ICD10CM | Covered |
| T46.0X1A | ICD10CM | Covered |
| T46.0X2A | ICD10CM | Covered |
| T46.0X3A | ICD10CM | Covered |
| T46.0X5A | ICD10CM | Covered |
| T46.1X1A | ICD10CM | Covered |
| T46.1X2A | ICD10CM | Covered |
| T46.1X3A | ICD10CM | Covered |
| T46.1X5A | ICD10CM | Covered |
| T46.2X1A | ICD10CM | Covered |
| T46.2X2A | ICD10CM | Covered |
| T46.2X3A | ICD10CM | Covered |
| T46.2X5A | ICD10CM | Covered |
| T46.3X1A | ICD10CM | Covered |
| T46.3X2A | ICD10CM | Covered |
| T46.3X3A | ICD10CM | Covered |
| T46.3X5A | ICD10CM | Covered |
| T46.4X1A | ICD10CM | Covered |
| T46.4X2A | ICD10CM | Covered |
| T46.4X3A | ICD10CM | Covered |
| T46.4X5A | ICD10CM | Covered |
| T46.5X1A | ICD10CM | Covered |
| T46.5X2A | ICD10CM | Covered |
| T46.5X3A | ICD10CM | Covered |
| T46.5X5A | ICD10CM | Covered |
| T46.6X1A | ICD10CM | Covered |
| T46.6X2A | ICD10CM | Covered |
| T46.6X3A | ICD10CM | Covered |
| T46.6X5A | ICD10CM | Covered |
| T46.7X1A | ICD10CM | Covered |
| T46.7X2A | ICD10CM | Covered |
| T46.7X3A | ICD10CM | Covered |
| T46.7X5A | ICD10CM | Covered |
| T46.8X1A | ICD10CM | Covered |
| T46.8X2A | ICD10CM | Covered |
| T46.8X3A | ICD10CM | Covered |
| T46.8X5A | ICD10CM | Covered |
| T46.901A | ICD10CM | Covered |
| T46.902A | ICD10CM | Covered |
| T46.903A | ICD10CM | Covered |
| T46.905A | ICD10CM | Covered |
| T46.991A | ICD10CM | Covered |
| T46.992A | ICD10CM | Covered |
| T46.993A | ICD10CM | Covered |
| T46.995A | ICD10CM | Covered |
| T47.0X5A | ICD10CM | Covered |
| T47.1X5A | ICD10CM | Covered |
| T47.2X5A | ICD10CM | Covered |
| T47.3X5A | ICD10CM | Covered |
| T47.4X5A | ICD10CM | Covered |
| T47.5X5A | ICD10CM | Covered |
| T47.6X5A | ICD10CM | Covered |
| T47.7X5A | ICD10CM | Covered |
| T47.8X5A | ICD10CM | Covered |
| T48.0X5A | ICD10CM | Covered |
| T48.1X5A | ICD10CM | Covered |
| T48.295A | ICD10CM | Covered |
| T48.3X5A | ICD10CM | Covered |
| T48.4X5A | ICD10CM | Covered |
| T48.5X5A | ICD10CM | Covered |
| T48.6X5A | ICD10CM | Covered |
| T48.995A | ICD10CM | Covered |
| T49.0X5A | ICD10CM | Covered |
| T49.1X5A | ICD10CM | Covered |
| T49.2X5A | ICD10CM | Covered |
| T49.3X5A | ICD10CM | Covered |
| T49.4X5A | ICD10CM | Covered |
| T49.5X5A | ICD10CM | Covered |
| T49.6X5A | ICD10CM | Covered |
| T49.7X5A | ICD10CM | Covered |
| T49.8X5A | ICD10CM | Covered |
| T50.0X1A | ICD10CM | Covered |
| T50.0X2A | ICD10CM | Covered |
| T50.0X3A | ICD10CM | Covered |
| T50.0X5A | ICD10CM | Covered |
| T50.1X5A | ICD10CM | Covered |
| T50.2X5A | ICD10CM | Covered |
| T50.3X5A | ICD10CM | Covered |
| T50.4X5A | ICD10CM | Covered |
| T50.5X5A | ICD10CM | Covered |
| T50.6X5A | ICD10CM | Covered |
| T50.7X5A | ICD10CM | Covered |
| T50.8X5A | ICD10CM | Covered |