About this policy
Jurisdiction: J6 MAC Part B. States: Illinois, Minnesota, Wisconsin. 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 1,300 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| J0881 | HCPCS | Covered |
| J0882 | HCPCS | Covered |
| J0885 | HCPCS | Covered |
| J0887 | HCPCS | Covered |
| J0888 | HCPCS | Covered |
| J0890 | HCPCS | Covered |
| Q4081 | HCPCS | Covered |
| Q5105 | HCPCS | Covered |
| Q5106 | HCPCS | Covered |
| B17.10 | ICD10CM | Covered |
| B17.11 | ICD10CM | Covered |
| B18.2 | ICD10CM | Covered |
| B19.20 | ICD10CM | Covered |
| B19.21 | ICD10CM | Covered |
| B20 | ICD10CM | Covered |
| B97.35 | ICD10CM | Covered |
| C00.0 | ICD10CM | Covered |
| C00.1 | ICD10CM | Covered |
| C00.2 | ICD10CM | Covered |
| C00.3 | ICD10CM | Covered |
| C00.4 | ICD10CM | Covered |
| C00.5 | ICD10CM | Covered |
| C00.6 | ICD10CM | Covered |
| C00.8 | ICD10CM | Covered |
| C01 | ICD10CM | Covered |
| C02.0 | ICD10CM | Covered |
| C02.1 | ICD10CM | Covered |
| C02.2 | ICD10CM | Covered |
| C02.3 | ICD10CM | Covered |
| C02.4 | ICD10CM | Covered |
| C02.8 | ICD10CM | Covered |
| C03.0 | ICD10CM | Covered |
| C03.1 | ICD10CM | Covered |
| C04.0 | ICD10CM | Covered |
| C04.1 | ICD10CM | Covered |
| C04.8 | ICD10CM | Covered |
| C05.0 | ICD10CM | Covered |
| C05.1 | ICD10CM | Covered |
| C05.2 | ICD10CM | Covered |
| C05.8 | ICD10CM | Covered |
| C06.0 | ICD10CM | Covered |
| C06.1 | ICD10CM | Covered |
| C06.2 | ICD10CM | Covered |
| C06.89 | ICD10CM | Covered |
| C07 | ICD10CM | Covered |
| C08.0 | ICD10CM | Covered |
| C08.1 | ICD10CM | Covered |
| C09.0 | ICD10CM | Covered |
| C09.1 | ICD10CM | Covered |
| C09.8 | ICD10CM | Covered |
| C10.0 | ICD10CM | Covered |
| C10.1 | ICD10CM | Covered |
| C10.2 | ICD10CM | Covered |
| C10.3 | ICD10CM | Covered |
| C10.4 | ICD10CM | Covered |
| C10.8 | ICD10CM | Covered |
| C11.0 | ICD10CM | Covered |
| C11.1 | ICD10CM | Covered |
| C11.2 | ICD10CM | Covered |
| C11.3 | ICD10CM | Covered |
| C11.8 | ICD10CM | Covered |
| C12 | ICD10CM | Covered |
| C13.0 | ICD10CM | Covered |
| C13.1 | ICD10CM | Covered |
| C13.2 | ICD10CM | Covered |
| C13.8 | ICD10CM | Covered |
| C14.0 | ICD10CM | Covered |
| C14.2 | ICD10CM | Covered |
| C14.8 | ICD10CM | Covered |
| C15.3 | ICD10CM | Covered |
| C15.4 | ICD10CM | Covered |
| C15.5 | ICD10CM | Covered |
| C15.8 | ICD10CM | Covered |
| C16.0 | ICD10CM | Covered |
| C16.1 | ICD10CM | Covered |
| C16.2 | ICD10CM | Covered |
| C16.3 | ICD10CM | Covered |
| C16.4 | ICD10CM | Covered |
| C16.5 | ICD10CM | Covered |
| C16.6 | ICD10CM | Covered |
| C16.8 | ICD10CM | Covered |
| C17.0 | ICD10CM | Covered |
| C17.1 | ICD10CM | Covered |
| C17.2 | ICD10CM | Covered |
| C17.3 | ICD10CM | Covered |
| C17.8 | ICD10CM | Covered |
| C18.0 | ICD10CM | Covered |
| C18.1 | ICD10CM | Covered |
| C18.2 | ICD10CM | Covered |
| C18.3 | ICD10CM | Covered |
| C18.4 | ICD10CM | Covered |
| C18.5 | ICD10CM | Covered |
| C18.6 | ICD10CM | Covered |
| C18.7 | ICD10CM | Covered |
| C18.8 | ICD10CM | Covered |
| C19 | ICD10CM | Covered |
| C20 | ICD10CM | Covered |
| C21.1 | ICD10CM | Covered |
| C21.2 | ICD10CM | Covered |
| C21.8 | ICD10CM | Covered |
| C22.0 | ICD10CM | Covered |
| C22.1 | ICD10CM | Covered |
| C22.2 | ICD10CM | Covered |
| C22.3 | ICD10CM | Covered |
| C22.4 | ICD10CM | Covered |
| C22.7 | ICD10CM | Covered |
| C22.8 | ICD10CM | Covered |
| C22.9 | ICD10CM | Covered |
| C23 | ICD10CM | Covered |
| C24.0 | ICD10CM | Covered |
| C24.1 | ICD10CM | Covered |
| C24.8 | ICD10CM | Covered |
| C25.0 | ICD10CM | Covered |
| C25.1 | ICD10CM | Covered |
| C25.2 | ICD10CM | Covered |
| C25.3 | ICD10CM | Covered |
| C25.4 | ICD10CM | Covered |
| C25.7 | ICD10CM | Covered |
| C25.8 | ICD10CM | Covered |
| C26.1 | ICD10CM | Covered |
| C30.0 | ICD10CM | Covered |
| C30.1 | ICD10CM | Covered |
| C31.0 | ICD10CM | Covered |
| C31.1 | ICD10CM | Covered |
| C31.2 | ICD10CM | Covered |
| C31.3 | ICD10CM | Covered |
| C31.8 | ICD10CM | Covered |
| C32.0 | ICD10CM | Covered |
| C32.1 | ICD10CM | Covered |
| C32.2 | ICD10CM | Covered |
| C32.3 | ICD10CM | Covered |
| C32.8 | ICD10CM | Covered |
| C33 | ICD10CM | Covered |
| C34.01 | ICD10CM | Covered |
| C34.02 | ICD10CM | Covered |
| C34.11 | ICD10CM | Covered |
| C34.12 | ICD10CM | Covered |
| C34.2 | ICD10CM | Covered |
| C34.31 | ICD10CM | Covered |
| C34.32 | ICD10CM | Covered |
| C34.81 | ICD10CM | Covered |
| C34.82 | ICD10CM | Covered |
| C37 | ICD10CM | Covered |
| C38.0 | ICD10CM | Covered |
| C38.1 | ICD10CM | Covered |
| C38.2 | ICD10CM | Covered |
| C38.4 | ICD10CM | Covered |
| C38.8 | ICD10CM | Covered |
| C40.01 | ICD10CM | Covered |
| C40.02 | ICD10CM | Covered |
| C40.11 | ICD10CM | Covered |
| C40.12 | ICD10CM | Covered |
| C40.21 | ICD10CM | Covered |
| C40.22 | ICD10CM | Covered |
| C40.31 | ICD10CM | Covered |
| C40.32 | ICD10CM | Covered |
| C40.81 | ICD10CM | Covered |
| C40.82 | ICD10CM | Covered |
| C41.0 | ICD10CM | Covered |
| C41.1 | ICD10CM | Covered |
| C41.2 | ICD10CM | Covered |
| C41.3 | ICD10CM | Covered |
| C41.4 | ICD10CM | Covered |
| C43.0 | ICD10CM | Covered |
| C43.111 | ICD10CM | Covered |
| C43.112 | ICD10CM | Covered |
| C43.121 | ICD10CM | Covered |
| C43.122 | ICD10CM | Covered |
| C43.21 | ICD10CM | Covered |
| C43.22 | ICD10CM | Covered |
| C43.31 | ICD10CM | Covered |
| C43.39 | ICD10CM | Covered |
| C43.4 | ICD10CM | Covered |
| C43.51 | ICD10CM | Covered |
| C43.52 | ICD10CM | Covered |
| C43.59 | ICD10CM | Covered |
| C43.61 | ICD10CM | Covered |
| C43.62 | ICD10CM | Covered |
| C43.71 | ICD10CM | Covered |
| C43.72 | ICD10CM | Covered |
| C43.8 | ICD10CM | Covered |
| C44.01 | ICD10CM | Covered |
| C44.02 | ICD10CM | Covered |
| C44.09 | ICD10CM | Covered |
| C44.1121 | ICD10CM | Covered |
| C44.1122 | ICD10CM | Covered |
| C44.1191 | ICD10CM | Covered |
| C44.1192 | ICD10CM | Covered |
| C44.1221 | ICD10CM | Covered |
| C44.1222 | ICD10CM | Covered |
| C44.1291 | ICD10CM | Covered |
| C44.1292 | ICD10CM | Covered |
| C44.1321 | ICD10CM | Covered |
| C44.1322 | ICD10CM | Covered |
| C44.1391 | ICD10CM | Covered |
| C44.1392 | ICD10CM | Covered |
| C44.1921 | ICD10CM | Covered |
| C44.1922 | ICD10CM | Covered |
| C44.1991 | ICD10CM | Covered |
| C44.1992 | ICD10CM | Covered |
| C44.212 | ICD10CM | Covered |
| C44.219 | ICD10CM | Covered |
| C44.222 | ICD10CM | Covered |
| C44.229 | ICD10CM | Covered |
| C44.292 | ICD10CM | Covered |
| C44.299 | ICD10CM | Covered |
| C44.311 | ICD10CM | Covered |
| C44.319 | ICD10CM | Covered |
| C44.321 | ICD10CM | Covered |
| C44.329 | ICD10CM | Covered |
| C44.391 | ICD10CM | Covered |
| C44.399 | ICD10CM | Covered |
| C44.41 | ICD10CM | Covered |
| C44.42 | ICD10CM | Covered |
| C44.49 | ICD10CM | Covered |
| C44.510 | ICD10CM | Covered |
| C44.511 | ICD10CM | Covered |
| C44.519 | ICD10CM | Covered |
| C44.520 | ICD10CM | Covered |
| C44.521 | ICD10CM | Covered |
| C44.529 | ICD10CM | Covered |
| C44.590 | ICD10CM | Covered |
| C44.591 | ICD10CM | Covered |
| C44.599 | ICD10CM | Covered |
| C44.612 | ICD10CM | Covered |
| C44.619 | ICD10CM | Covered |
| C44.622 | ICD10CM | Covered |
| C44.629 | ICD10CM | Covered |
| C44.692 | ICD10CM | Covered |
| C44.699 | ICD10CM | Covered |
| C44.712 | ICD10CM | Covered |
| C44.719 | ICD10CM | Covered |
| C44.722 | ICD10CM | Covered |
| C44.729 | ICD10CM | Covered |
| C44.792 | ICD10CM | Covered |
| C44.799 | ICD10CM | Covered |
| C44.81 | ICD10CM | Covered |
| C44.82 | ICD10CM | Covered |
| C44.89 | ICD10CM | Covered |
| C45.0 | ICD10CM | Covered |
| C45.1 | ICD10CM | Covered |
| C45.2 | ICD10CM | Covered |
| C45.7 | ICD10CM | Covered |
| C46.0 | ICD10CM | Covered |
| C46.1 | ICD10CM | Covered |
| C46.2 | ICD10CM | Covered |
| C46.3 | ICD10CM | Covered |
| C46.4 | ICD10CM | Covered |
| C46.51 | ICD10CM | Covered |
| C46.52 | ICD10CM | Covered |
| C46.7 | ICD10CM | Covered |
| C47.0 | ICD10CM | Covered |
| C47.11 | ICD10CM | Covered |
| C47.12 | ICD10CM | Covered |
| C47.21 | ICD10CM | Covered |
| C47.22 | ICD10CM | Covered |
| C47.3 | ICD10CM | Covered |
| C47.4 | ICD10CM | Covered |
| C47.5 | ICD10CM | Covered |
| C47.6 | ICD10CM | Covered |
| C47.8 | ICD10CM | Covered |
| C48.0 | ICD10CM | Covered |
| C48.1 | ICD10CM | Covered |
| C48.8 | ICD10CM | Covered |
| C49.0 | ICD10CM | Covered |
| C49.11 | ICD10CM | Covered |
| C49.12 | ICD10CM | Covered |
| C49.21 | ICD10CM | Covered |
| C49.22 | ICD10CM | Covered |
| C49.3 | ICD10CM | Covered |
| C49.4 | ICD10CM | Covered |
| C49.5 | ICD10CM | Covered |
| C49.6 | ICD10CM | Covered |
| C49.8 | ICD10CM | Covered |
| C49.A1 | ICD10CM | Covered |
| C49.A2 | ICD10CM | Covered |
| C49.A3 | ICD10CM | Covered |
| C49.A4 | ICD10CM | Covered |
| C49.A5 | ICD10CM | Covered |
| C49.A9 | ICD10CM | Covered |
| C4A.0 | ICD10CM | Covered |
| C4A.111 | ICD10CM | Covered |
| C4A.112 | ICD10CM | Covered |
| C4A.121 | ICD10CM | Covered |
| C4A.122 | ICD10CM | Covered |
| C4A.21 | ICD10CM | Covered |
| C4A.22 | ICD10CM | Covered |
| C4A.31 | ICD10CM | Covered |
| C4A.39 | ICD10CM | Covered |
| C4A.4 | ICD10CM | Covered |
| C4A.51 | ICD10CM | Covered |
| C4A.52 | ICD10CM | Covered |
| C4A.59 | ICD10CM | Covered |
| C4A.61 | ICD10CM | Covered |
| C4A.62 | ICD10CM | Covered |
| C4A.71 | ICD10CM | Covered |
| C4A.72 | ICD10CM | Covered |
| C4A.8 | ICD10CM | Covered |
| C50.011 | ICD10CM | Covered |
| C50.012 | ICD10CM | Covered |
| C50.021 | ICD10CM | Covered |
| C50.022 | ICD10CM | Covered |
| C50.111 | ICD10CM | Covered |
| C50.112 | ICD10CM | Covered |
| C50.121 | ICD10CM | Covered |
| C50.122 | ICD10CM | Covered |
| C50.211 | ICD10CM | Covered |
| C50.212 | ICD10CM | Covered |
| C50.221 | ICD10CM | Covered |
| C50.222 | ICD10CM | Covered |
| C50.311 | ICD10CM | Covered |
| C50.312 | ICD10CM | Covered |
| C50.321 | ICD10CM | Covered |
| C50.322 | ICD10CM | Covered |
| C50.411 | ICD10CM | Covered |
| C50.412 | ICD10CM | Covered |
| C50.421 | ICD10CM | Covered |
| C50.422 | ICD10CM | Covered |
| C50.511 | ICD10CM | Covered |
| C50.512 | ICD10CM | Covered |
| C50.521 | ICD10CM | Covered |
| C50.522 | ICD10CM | Covered |
| C50.611 | ICD10CM | Covered |
| C50.612 | ICD10CM | Covered |
| C50.621 | ICD10CM | Covered |
| C50.622 | ICD10CM | Covered |
| C50.811 | ICD10CM | Covered |
| C50.812 | ICD10CM | Covered |
| C50.821 | ICD10CM | Covered |
| C50.822 | ICD10CM | Covered |
| C50.911 | ICD10CM | Covered |
| C50.912 | ICD10CM | Covered |
| C50.921 | ICD10CM | Covered |
| C50.922 | ICD10CM | Covered |
| C51.0 | ICD10CM | Covered |
| C51.1 | ICD10CM | Covered |
| C51.2 | ICD10CM | Covered |
| C51.8 | ICD10CM | Covered |
| C52 | ICD10CM | Covered |
| C53.0 | ICD10CM | Covered |
| C53.1 | ICD10CM | Covered |
| C53.8 | ICD10CM | Covered |
| C54.0 | ICD10CM | Covered |
| C54.1 | ICD10CM | Covered |
| C54.2 | ICD10CM | Covered |
| C54.3 | ICD10CM | Covered |
| C54.8 | ICD10CM | Covered |
| C56.1 | ICD10CM | Covered |
| C56.2 | ICD10CM | Covered |
| C56.3 | ICD10CM | Covered |
| C57.01 | ICD10CM | Covered |
| C57.02 | ICD10CM | Covered |
| C57.11 | ICD10CM | Covered |
| C57.12 | ICD10CM | Covered |
| C57.21 | ICD10CM | Covered |
| C57.22 | ICD10CM | Covered |
| C57.3 | ICD10CM | Covered |
| C57.7 | ICD10CM | Covered |
| C57.8 | ICD10CM | Covered |
| C58 | ICD10CM | Covered |
| C60.0 | ICD10CM | Covered |
| C60.1 | ICD10CM | Covered |
| C60.2 | ICD10CM | Covered |
| C60.8 | ICD10CM | Covered |
| C61 | ICD10CM | Covered |
| C62.01 | ICD10CM | Covered |
| C62.02 | ICD10CM | Covered |
| C62.11 | ICD10CM | Covered |
| C62.12 | ICD10CM | Covered |
| C63.01 | ICD10CM | Covered |
| C63.02 | ICD10CM | Covered |
| C63.11 | ICD10CM | Covered |
| C63.12 | ICD10CM | Covered |
| C63.2 | ICD10CM | Covered |
| C63.7 | ICD10CM | Covered |
| C63.8 | ICD10CM | Covered |
| C64.1 | ICD10CM | Covered |
| C64.2 | ICD10CM | Covered |
| C65.1 | ICD10CM | Covered |
| C65.2 | ICD10CM | Covered |
| C66.1 | ICD10CM | Covered |
| C66.2 | ICD10CM | Covered |
| C67.0 | ICD10CM | Covered |
| C67.1 | ICD10CM | Covered |
| C67.2 | ICD10CM | Covered |
| C67.3 | ICD10CM | Covered |
| C67.4 | ICD10CM | Covered |
| C67.5 | ICD10CM | Covered |
| C67.6 | ICD10CM | Covered |
| C67.7 | ICD10CM | Covered |
| C67.8 | ICD10CM | Covered |
| C68.0 | ICD10CM | Covered |
| C68.1 | ICD10CM | Covered |
| C68.8 | ICD10CM | Covered |
| C69.01 | ICD10CM | Covered |
| C69.02 | ICD10CM | Covered |
| C69.11 | ICD10CM | Covered |
| C69.12 | ICD10CM | Covered |
| C69.21 | ICD10CM | Covered |
| C69.22 | ICD10CM | Covered |
| C69.31 | ICD10CM | Covered |
| C69.32 | ICD10CM | Covered |
| C69.41 | ICD10CM | Covered |
| C69.42 | ICD10CM | Covered |
| C69.51 | ICD10CM | Covered |
| C69.52 | ICD10CM | Covered |
| C69.61 | ICD10CM | Covered |
| C69.62 | ICD10CM | Covered |
| C69.81 | ICD10CM | Covered |
| C69.82 | ICD10CM | Covered |
| C70.0 | ICD10CM | Covered |
| C70.1 | ICD10CM | Covered |
| C71.0 | ICD10CM | Covered |
| C71.1 | ICD10CM | Covered |
| C71.2 | ICD10CM | Covered |
| C71.3 | ICD10CM | Covered |
| C71.4 | ICD10CM | Covered |
| C71.5 | ICD10CM | Covered |
| C71.6 | ICD10CM | Covered |
| C71.7 | ICD10CM | Covered |
| C71.8 | ICD10CM | Covered |
| C72.0 | ICD10CM | Covered |
| C72.1 | ICD10CM | Covered |
| C72.21 | ICD10CM | Covered |
| C72.22 | ICD10CM | Covered |
| C72.31 | ICD10CM | Covered |
| C72.32 | ICD10CM | Covered |
| C72.41 | ICD10CM | Covered |
| C72.42 | ICD10CM | Covered |
| C72.59 | ICD10CM | Covered |
| C73 | ICD10CM | Covered |
| C74.01 | ICD10CM | Covered |
| C74.02 | ICD10CM | Covered |
| C74.11 | ICD10CM | Covered |
| C74.12 | ICD10CM | Covered |
| C75.0 | ICD10CM | Covered |
| C75.1 | ICD10CM | Covered |
| C75.2 | ICD10CM | Covered |
| C75.3 | ICD10CM | Covered |
| C75.4 | ICD10CM | Covered |
| C75.5 | ICD10CM | Covered |
| C75.8 | ICD10CM | Covered |
| C76.0 | ICD10CM | Covered |
| C76.1 | ICD10CM | Covered |
| C76.2 | ICD10CM | Covered |
| C76.3 | ICD10CM | Covered |
| C76.41 | ICD10CM | Covered |
| C76.42 | ICD10CM | Covered |
| C76.51 | ICD10CM | Covered |
| C76.52 | ICD10CM | Covered |
| C76.8 | ICD10CM | Covered |
| C77.0 | ICD10CM | Covered |
| C77.1 | ICD10CM | Covered |
| C77.2 | ICD10CM | Covered |
| C77.3 | ICD10CM | Covered |
| C77.4 | ICD10CM | Covered |
| C77.5 | ICD10CM | Covered |
| C77.8 | ICD10CM | Covered |
| C78.01 | ICD10CM | Covered |
| C78.02 | ICD10CM | Covered |
| C78.1 | ICD10CM | Covered |
| C78.2 | ICD10CM | Covered |
| C78.39 | ICD10CM | Covered |
| C78.4 | ICD10CM | Covered |
| C78.5 | ICD10CM | Covered |
| C78.6 | ICD10CM | Covered |
| C78.7 | ICD10CM | Covered |
| C78.89 | ICD10CM | Covered |
| C79.01 | ICD10CM | Covered |
| C79.02 | ICD10CM | Covered |
| C79.11 | ICD10CM | Covered |
| C79.19 | ICD10CM | Covered |
| C79.2 | ICD10CM | Covered |
| C79.31 | ICD10CM | Covered |
| C79.32 | ICD10CM | Covered |
| C79.49 | ICD10CM | Covered |
| C79.51 | ICD10CM | Covered |
| C79.52 | ICD10CM | Covered |
| C79.61 | ICD10CM | Covered |
| C79.62 | ICD10CM | Covered |
| C79.71 | ICD10CM | Covered |
| C79.72 | ICD10CM | Covered |
| C79.81 | ICD10CM | Covered |
| C79.82 | ICD10CM | Covered |
| C79.89 | ICD10CM | Covered |
| C7A.010 | ICD10CM | Covered |
| C7A.011 | ICD10CM | Covered |
| C7A.012 | ICD10CM | Covered |
| C7A.020 | ICD10CM | Covered |
| C7A.021 | ICD10CM | Covered |
| C7A.022 | ICD10CM | Covered |
| C7A.023 | ICD10CM | Covered |
| C7A.024 | ICD10CM | Covered |
| C7A.025 | ICD10CM | Covered |
| C7A.026 | ICD10CM | Covered |
| C7A.090 | ICD10CM | Covered |
| C7A.091 | ICD10CM | Covered |
| C7A.092 | ICD10CM | Covered |
| C7A.093 | ICD10CM | Covered |
| C7A.094 | ICD10CM | Covered |
| C7A.095 | ICD10CM | Covered |
| C7A.096 | ICD10CM | Covered |
| C7A.098 | ICD10CM | Covered |
| C7A.1 | ICD10CM | Covered |
| C7A.8 | ICD10CM | Covered |
| C7B.01 | ICD10CM | Covered |
| C7B.02 | ICD10CM | Covered |
| C7B.03 | ICD10CM | Covered |
| C7B.04 | ICD10CM | Covered |
| C7B.09 | ICD10CM | Covered |
| C7B.1 | ICD10CM | Covered |
| C7B.8 | ICD10CM | Covered |
| C80.0 | ICD10CM | Covered |
| C80.1 | ICD10CM | Covered |
| C80.2 | ICD10CM | Covered |
| C81.01 | ICD10CM | Covered |
| C81.02 | ICD10CM | Covered |
| C81.03 | ICD10CM | Covered |
| C81.04 | ICD10CM | Covered |
| C81.05 | ICD10CM | Covered |
| C81.06 | ICD10CM | Covered |
| C81.07 | ICD10CM | Covered |
| C81.08 | ICD10CM | Covered |
| C81.09 | ICD10CM | Covered |
| C81.11 | ICD10CM | Covered |
| C81.12 | ICD10CM | Covered |
| C81.13 | ICD10CM | Covered |
| C81.14 | ICD10CM | Covered |
| C81.15 | ICD10CM | Covered |
| C81.16 | ICD10CM | Covered |
| C81.17 | ICD10CM | Covered |
| C81.18 | ICD10CM | Covered |
| C81.19 | ICD10CM | Covered |
| C81.21 | ICD10CM | Covered |
| C81.22 | ICD10CM | Covered |
| C81.23 | ICD10CM | Covered |
| C81.24 | ICD10CM | Covered |
| C81.25 | ICD10CM | Covered |
| C81.26 | ICD10CM | Covered |
| C81.27 | ICD10CM | Covered |
| C81.28 | ICD10CM | Covered |
| C81.29 | ICD10CM | Covered |
| C81.31 | ICD10CM | Covered |
| C81.32 | ICD10CM | Covered |
| C81.33 | ICD10CM | Covered |
| C81.34 | ICD10CM | Covered |
| C81.35 | ICD10CM | Covered |
| C81.36 | ICD10CM | Covered |
| C81.37 | ICD10CM | Covered |
| C81.38 | ICD10CM | Covered |
| C81.39 | ICD10CM | Covered |
| C81.41 | ICD10CM | Covered |
| C81.42 | ICD10CM | Covered |
| C81.43 | ICD10CM | Covered |
| C81.44 | ICD10CM | Covered |
| C81.45 | ICD10CM | Covered |
| C81.46 | ICD10CM | Covered |
| C81.47 | ICD10CM | Covered |
| C81.48 | ICD10CM | Covered |
| C81.49 | ICD10CM | Covered |
| C81.71 | ICD10CM | Covered |
| C81.72 | ICD10CM | Covered |
| C81.73 | ICD10CM | Covered |
| C81.74 | ICD10CM | Covered |
| C81.75 | ICD10CM | Covered |
| C81.76 | ICD10CM | Covered |
| C81.77 | ICD10CM | Covered |
| C81.78 | ICD10CM | Covered |
| C81.79 | ICD10CM | Covered |
| C81.91 | ICD10CM | Covered |
| C81.92 | ICD10CM | Covered |
| C81.93 | ICD10CM | Covered |
| C81.94 | ICD10CM | Covered |
| C81.95 | ICD10CM | Covered |
| C81.96 | ICD10CM | Covered |
| C81.97 | ICD10CM | Covered |
| C81.98 | ICD10CM | Covered |
| C81.99 | ICD10CM | Covered |
| C82.01 | ICD10CM | Covered |
| C82.02 | ICD10CM | Covered |
| C82.03 | ICD10CM | Covered |
| C82.04 | ICD10CM | Covered |
| C82.05 | ICD10CM | Covered |
| C82.06 | ICD10CM | Covered |
| C82.07 | ICD10CM | Covered |
| C82.08 | ICD10CM | Covered |
| C82.09 | ICD10CM | Covered |
| C82.11 | ICD10CM | Covered |
| C82.12 | ICD10CM | Covered |
| C82.13 | ICD10CM | Covered |
| C82.14 | ICD10CM | Covered |
| C82.15 | ICD10CM | Covered |
| C82.16 | ICD10CM | Covered |
| C82.17 | ICD10CM | Covered |
| C82.18 | ICD10CM | Covered |
| C82.19 | ICD10CM | Covered |
| C82.21 | ICD10CM | Covered |
| C82.22 | ICD10CM | Covered |
| C82.23 | ICD10CM | Covered |
| C82.24 | ICD10CM | Covered |
| C82.25 | ICD10CM | Covered |
| C82.26 | ICD10CM | Covered |
| C82.27 | ICD10CM | Covered |
| C82.28 | ICD10CM | Covered |
| C82.29 | ICD10CM | Covered |
| C82.31 | ICD10CM | Covered |
| C82.32 | ICD10CM | Covered |
| C82.33 | ICD10CM | Covered |
| C82.34 | ICD10CM | Covered |
| C82.35 | ICD10CM | Covered |
| C82.36 | ICD10CM | Covered |
| C82.37 | ICD10CM | Covered |
| C82.38 | ICD10CM | Covered |
| C82.39 | ICD10CM | Covered |
| C82.41 | ICD10CM | Covered |
| C82.42 | ICD10CM | Covered |
| C82.43 | ICD10CM | Covered |
| C82.44 | ICD10CM | Covered |
| C82.45 | ICD10CM | Covered |
| C82.46 | ICD10CM | Covered |
| C82.47 | ICD10CM | Covered |
| C82.48 | ICD10CM | Covered |
| C82.49 | ICD10CM | Covered |
| C82.51 | ICD10CM | Covered |
| C82.52 | ICD10CM | Covered |
| C82.53 | ICD10CM | Covered |
| C82.54 | ICD10CM | Covered |
| C82.55 | ICD10CM | Covered |
| C82.56 | ICD10CM | Covered |
| C82.57 | ICD10CM | Covered |
| C82.58 | ICD10CM | Covered |
| C82.59 | ICD10CM | Covered |
| C82.61 | ICD10CM | Covered |
| C82.62 | ICD10CM | Covered |
| C82.63 | ICD10CM | Covered |
| C82.64 | ICD10CM | Covered |
| C82.65 | ICD10CM | Covered |
| C82.66 | ICD10CM | Covered |
| C82.67 | ICD10CM | Covered |
| C82.68 | ICD10CM | Covered |
| C82.69 | ICD10CM | Covered |
| C82.81 | ICD10CM | Covered |
| C82.82 | ICD10CM | Covered |
| C82.83 | ICD10CM | Covered |
| C82.84 | ICD10CM | Covered |
| C82.85 | ICD10CM | Covered |
| C82.86 | ICD10CM | Covered |
| C82.87 | ICD10CM | Covered |
| C82.88 | ICD10CM | Covered |
| C82.89 | ICD10CM | Covered |
| C82.91 | ICD10CM | Covered |
| C82.92 | ICD10CM | Covered |
| C82.93 | ICD10CM | Covered |
| C82.94 | ICD10CM | Covered |
| C82.95 | ICD10CM | Covered |
| C82.96 | ICD10CM | Covered |
| C82.97 | ICD10CM | Covered |
| C82.98 | ICD10CM | Covered |
| C82.99 | ICD10CM | Covered |
| C83.01 | ICD10CM | Covered |
| C83.02 | ICD10CM | Covered |
| C83.03 | ICD10CM | Covered |
| C83.04 | ICD10CM | Covered |
| C83.05 | ICD10CM | Covered |
| C83.06 | ICD10CM | Covered |
| C83.07 | ICD10CM | Covered |
| C83.08 | ICD10CM | Covered |
| C83.09 | ICD10CM | Covered |
| C83.11 | ICD10CM | Covered |
| C83.12 | ICD10CM | Covered |
| C83.13 | ICD10CM | Covered |
| C83.14 | ICD10CM | Covered |
| C83.15 | ICD10CM | Covered |
| C83.16 | ICD10CM | Covered |
| C83.17 | ICD10CM | Covered |
| C83.18 | ICD10CM | Covered |
| C83.19 | ICD10CM | Covered |
| C83.31 | ICD10CM | Covered |
| C83.32 | ICD10CM | Covered |
| C83.33 | ICD10CM | Covered |
| C83.34 | ICD10CM | Covered |
| C83.35 | ICD10CM | Covered |
| C83.36 | ICD10CM | Covered |
| C83.37 | ICD10CM | Covered |
| C83.38 | ICD10CM | Covered |
| C83.390 | ICD10CM | Covered |
| C83.398 | ICD10CM | Covered |
| C83.51 | ICD10CM | Covered |
| C83.52 | ICD10CM | Covered |
| C83.53 | ICD10CM | Covered |
| C83.54 | ICD10CM | Covered |
| C83.55 | ICD10CM | Covered |
| C83.56 | ICD10CM | Covered |
| C83.57 | ICD10CM | Covered |
| C83.58 | ICD10CM | Covered |
| C83.59 | ICD10CM | Covered |
| C83.71 | ICD10CM | Covered |
| C83.72 | ICD10CM | Covered |
| C83.73 | ICD10CM | Covered |
| C83.74 | ICD10CM | Covered |
| C83.75 | ICD10CM | Covered |
| C83.76 | ICD10CM | Covered |
| C83.77 | ICD10CM | Covered |
| C83.78 | ICD10CM | Covered |
| C83.79 | ICD10CM | Covered |
| C83.81 | ICD10CM | Covered |
| C83.82 | ICD10CM | Covered |
| C83.83 | ICD10CM | Covered |
| C83.84 | ICD10CM | Covered |
| C83.85 | ICD10CM | Covered |
| C83.86 | ICD10CM | Covered |
| C83.87 | ICD10CM | Covered |
| C83.88 | ICD10CM | Covered |
| C83.89 | ICD10CM | Covered |
| C83.91 | ICD10CM | Covered |
| C83.92 | ICD10CM | Covered |
| C83.93 | ICD10CM | Covered |
| C83.94 | ICD10CM | Covered |
| C83.95 | ICD10CM | Covered |
| C83.96 | ICD10CM | Covered |
| C83.97 | ICD10CM | Covered |
| C83.98 | ICD10CM | Covered |
| C83.99 | ICD10CM | Covered |
| C84.01 | ICD10CM | Covered |
| C84.02 | ICD10CM | Covered |
| C84.03 | ICD10CM | Covered |
| C84.04 | ICD10CM | Covered |
| C84.05 | ICD10CM | Covered |
| C84.06 | ICD10CM | Covered |
| C84.07 | ICD10CM | Covered |
| C84.08 | ICD10CM | Covered |
| C84.09 | ICD10CM | Covered |
| C84.11 | ICD10CM | Covered |
| C84.12 | ICD10CM | Covered |
| C84.13 | ICD10CM | Covered |
| C84.14 | ICD10CM | Covered |
| C84.15 | ICD10CM | Covered |
| C84.16 | ICD10CM | Covered |
| C84.17 | ICD10CM | Covered |
| C84.18 | ICD10CM | Covered |
| C84.19 | ICD10CM | Covered |
| C84.41 | ICD10CM | Covered |
| C84.42 | ICD10CM | Covered |
| C84.43 | ICD10CM | Covered |
| C84.44 | ICD10CM | Covered |
| C84.45 | ICD10CM | Covered |
| C84.46 | ICD10CM | Covered |
| C84.47 | ICD10CM | Covered |
| C84.48 | ICD10CM | Covered |
| C84.49 | ICD10CM | Covered |
| C84.61 | ICD10CM | Covered |
| C84.62 | ICD10CM | Covered |
| C84.63 | ICD10CM | Covered |
| C84.64 | ICD10CM | Covered |
| C84.65 | ICD10CM | Covered |
| C84.66 | ICD10CM | Covered |
| C84.67 | ICD10CM | Covered |
| C84.68 | ICD10CM | Covered |
| C84.69 | ICD10CM | Covered |
| C84.71 | ICD10CM | Covered |
| C84.72 | ICD10CM | Covered |
| C84.73 | ICD10CM | Covered |
| C84.74 | ICD10CM | Covered |
| C84.75 | ICD10CM | Covered |
| C84.76 | ICD10CM | Covered |
| C84.77 | ICD10CM | Covered |
| C84.78 | ICD10CM | Covered |
| C84.79 | ICD10CM | Covered |
| C84.91 | ICD10CM | Covered |
| C84.92 | ICD10CM | Covered |
| C84.93 | ICD10CM | Covered |
| C84.94 | ICD10CM | Covered |
| C84.95 | ICD10CM | Covered |
| C84.96 | ICD10CM | Covered |
| C84.97 | ICD10CM | Covered |
| C84.98 | ICD10CM | Covered |
| C84.99 | ICD10CM | Covered |
| C84.A1 | ICD10CM | Covered |
| C84.A2 | ICD10CM | Covered |
| C84.A3 | ICD10CM | Covered |
| C84.A4 | ICD10CM | Covered |
| C84.A5 | ICD10CM | Covered |
| C84.A6 | ICD10CM | Covered |
| C84.A7 | ICD10CM | Covered |
| C84.A8 | ICD10CM | Covered |
| C84.A9 | ICD10CM | Covered |
| C84.Z1 | ICD10CM | Covered |
| C84.Z2 | ICD10CM | Covered |
| C84.Z3 | ICD10CM | Covered |
| C84.Z4 | ICD10CM | Covered |
| C84.Z5 | ICD10CM | Covered |
| C84.Z6 | ICD10CM | Covered |
| C84.Z7 | ICD10CM | Covered |
| C84.Z8 | ICD10CM | Covered |
| C84.Z9 | ICD10CM | Covered |
| C85.11 | ICD10CM | Covered |
| C85.12 | ICD10CM | Covered |
| C85.13 | ICD10CM | Covered |
| C85.14 | ICD10CM | Covered |
| C85.15 | ICD10CM | Covered |
| C85.16 | ICD10CM | Covered |
| C85.17 | ICD10CM | Covered |
| C85.18 | ICD10CM | Covered |
| C85.19 | ICD10CM | Covered |
| C85.21 | ICD10CM | Covered |
| C85.22 | ICD10CM | Covered |
| C85.23 | ICD10CM | Covered |
| C85.24 | ICD10CM | Covered |
| C85.25 | ICD10CM | Covered |
| C85.26 | ICD10CM | Covered |
| C85.27 | ICD10CM | Covered |
| C85.28 | ICD10CM | Covered |
| C85.29 | ICD10CM | Covered |
| C85.81 | ICD10CM | Covered |
| C85.82 | ICD10CM | Covered |
| C85.83 | ICD10CM | Covered |
| C85.84 | ICD10CM | Covered |
| C85.85 | ICD10CM | Covered |
| C85.86 | ICD10CM | Covered |
| C85.87 | ICD10CM | Covered |
| C85.88 | ICD10CM | Covered |
| C85.89 | ICD10CM | Covered |
| C85.91 | ICD10CM | Covered |
| C85.92 | ICD10CM | Covered |
| C85.93 | ICD10CM | Covered |
| C85.94 | ICD10CM | Covered |
| C85.95 | ICD10CM | Covered |
| C85.96 | ICD10CM | Covered |
| C85.97 | ICD10CM | Covered |
| C85.98 | ICD10CM | Covered |
| C85.99 | ICD10CM | Covered |
| C86.00 | ICD10CM | Covered |
| C86.10 | ICD10CM | Covered |
| C86.20 | ICD10CM | Covered |
| C86.30 | ICD10CM | Covered |
| C86.40 | ICD10CM | Covered |
| C86.50 | ICD10CM | Covered |
| C86.60 | ICD10CM | Covered |
| C88.00 | ICD10CM | Covered |
| C88.20 | ICD10CM | Covered |
| C88.30 | ICD10CM | Covered |
| C88.40 | ICD10CM | Covered |
| C88.80 | ICD10CM | Covered |
| C88.90 | ICD10CM | Covered |
| C90.00 | ICD10CM | Covered |
| C90.02 | ICD10CM | Covered |
| C90.10 | ICD10CM | Covered |
| C90.12 | ICD10CM | Covered |
| C90.20 | ICD10CM | Covered |
| C90.22 | ICD10CM | Covered |
| C90.30 | ICD10CM | Covered |
| C90.32 | ICD10CM | Covered |
| C91.00 | ICD10CM | Covered |
| C91.02 | ICD10CM | Covered |
| C91.10 | ICD10CM | Covered |
| C91.12 | ICD10CM | Covered |
| C91.30 | ICD10CM | Covered |
| C91.32 | ICD10CM | Covered |
| C91.40 | ICD10CM | Covered |
| C91.42 | ICD10CM | Covered |
| C91.50 | ICD10CM | Covered |
| C91.52 | ICD10CM | Covered |
| C91.60 | ICD10CM | Covered |
| C91.62 | ICD10CM | Covered |
| C91.90 | ICD10CM | Covered |
| C91.92 | ICD10CM | Covered |
| C91.A0 | ICD10CM | Covered |
| C91.A2 | ICD10CM | Covered |
| C91.Z0 | ICD10CM | Covered |
| C91.Z2 | ICD10CM | Covered |
| C96.0 | ICD10CM | Covered |
| C96.20 | ICD10CM | Covered |
| C96.21 | ICD10CM | Covered |
| C96.22 | ICD10CM | Covered |
| C96.29 | ICD10CM | Covered |
| C96.4 | ICD10CM | Covered |
| C96.A | ICD10CM | Covered |
| C96.Z | ICD10CM | Covered |
| D00.01 | ICD10CM | Covered |
| D00.02 | ICD10CM | Covered |
| D00.03 | ICD10CM | Covered |
| D00.04 | ICD10CM | Covered |
| D00.05 | ICD10CM | Covered |
| D00.06 | ICD10CM | Covered |
| D00.07 | ICD10CM | Covered |
| D00.08 | ICD10CM | Covered |
| D00.1 | ICD10CM | Covered |
| D00.2 | ICD10CM | Covered |
| D01.0 | ICD10CM | Covered |
| D01.1 | ICD10CM | Covered |
| D01.2 | ICD10CM | Covered |
| D01.3 | ICD10CM | Covered |
| D01.49 | ICD10CM | Covered |
| D01.5 | ICD10CM | Covered |
| D01.7 | ICD10CM | Covered |
| D02.0 | ICD10CM | Covered |
| D02.1 | ICD10CM | Covered |
| D02.21 | ICD10CM | Covered |
| D02.22 | ICD10CM | Covered |
| D02.3 | ICD10CM | Covered |
| D03.0 | ICD10CM | Covered |
| D03.111 | ICD10CM | Covered |
| D03.112 | ICD10CM | Covered |
| D03.121 | ICD10CM | Covered |
| D03.122 | ICD10CM | Covered |
| D03.21 | ICD10CM | Covered |
| D03.22 | ICD10CM | Covered |
| D03.39 | ICD10CM | Covered |
| D03.4 | ICD10CM | Covered |
| D03.51 | ICD10CM | Covered |
| D03.52 | ICD10CM | Covered |
| D03.59 | ICD10CM | Covered |
| D03.61 | ICD10CM | Covered |
| D03.62 | ICD10CM | Covered |
| D03.71 | ICD10CM | Covered |
| D03.72 | ICD10CM | Covered |
| D03.8 | ICD10CM | Covered |
| D04.0 | ICD10CM | Covered |
| D04.111 | ICD10CM | Covered |
| D04.112 | ICD10CM | Covered |
| D04.121 | ICD10CM | Covered |
| D04.122 | ICD10CM | Covered |
| D04.21 | ICD10CM | Covered |
| D04.22 | ICD10CM | Covered |
| D04.39 | ICD10CM | Covered |
| D04.4 | ICD10CM | Covered |
| D04.5 | ICD10CM | Covered |
| D04.61 | ICD10CM | Covered |
| D04.62 | ICD10CM | Covered |
| D04.71 | ICD10CM | Covered |
| D04.72 | ICD10CM | Covered |
| D04.8 | ICD10CM | Covered |
| D05.01 | ICD10CM | Covered |
| D05.02 | ICD10CM | Covered |
| D05.11 | ICD10CM | Covered |
| D05.12 | ICD10CM | Covered |
| D05.81 | ICD10CM | Covered |
| D05.82 | ICD10CM | Covered |
| D05.91 | ICD10CM | Covered |
| D05.92 | ICD10CM | Covered |
| D06.0 | ICD10CM | Covered |
| D06.1 | ICD10CM | Covered |
| D06.7 | ICD10CM | Covered |
| D07.0 | ICD10CM | Covered |
| D07.1 | ICD10CM | Covered |
| D07.2 | ICD10CM | Covered |
| D07.39 | ICD10CM | Covered |
| D07.4 | ICD10CM | Covered |
| D07.5 | ICD10CM | Covered |
| D07.61 | ICD10CM | Covered |
| D07.69 | ICD10CM | Covered |
| D09.0 | ICD10CM | Covered |
| D09.19 | ICD10CM | Covered |
| D09.21 | ICD10CM | Covered |
| D09.22 | ICD10CM | Covered |
| D09.3 | ICD10CM | Covered |
| D09.8 | ICD10CM | Covered |
| D37.01 | ICD10CM | Covered |
| D37.02 | ICD10CM | Covered |
| D37.030 | ICD10CM | Covered |
| D37.031 | ICD10CM | Covered |
| D37.032 | ICD10CM | Covered |
| D37.039 | ICD10CM | Covered |
| D37.04 | ICD10CM | Covered |
| D37.05 | ICD10CM | Covered |
| D37.09 | ICD10CM | Covered |
| D37.1 | ICD10CM | Covered |
| D37.2 | ICD10CM | Covered |
| D37.3 | ICD10CM | Covered |
| D37.4 | ICD10CM | Covered |
| D37.5 | ICD10CM | Covered |
| D37.6 | ICD10CM | Covered |
| D37.8 | ICD10CM | Covered |
| D38.0 | ICD10CM | Covered |
| D38.1 | ICD10CM | Covered |
| D38.2 | ICD10CM | Covered |
| D38.3 | ICD10CM | Covered |
| D38.4 | ICD10CM | Covered |
| D38.5 | ICD10CM | Covered |
| D39.0 | ICD10CM | Covered |
| D39.11 | ICD10CM | Covered |
| D39.12 | ICD10CM | Covered |
| D39.2 | ICD10CM | Covered |
| D39.8 | ICD10CM | Covered |
| D40.0 | ICD10CM | Covered |
| D40.11 | ICD10CM | Covered |
| D40.12 | ICD10CM | Covered |
| D41.11 | ICD10CM | Covered |
| D41.12 | ICD10CM | Covered |
| D41.20 | ICD10CM | Covered |
| D41.21 | ICD10CM | Covered |
| D41.22 | ICD10CM | Covered |
| D41.3 | ICD10CM | Covered |
| D41.4 | ICD10CM | Covered |
| D41.8 | ICD10CM | Covered |
| D42.0 | ICD10CM | Covered |
| D42.1 | ICD10CM | Covered |
| D43.0 | ICD10CM | Covered |
| D43.1 | ICD10CM | Covered |
| D43.2 | ICD10CM | Covered |