About this policy
Jurisdiction: J8 MAC Part B. States: Indiana, Michigan. 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 1,177 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 51785 | CPT | Covered |
| 92265 | CPT | Covered |
| 95860 | CPT | Covered |
| 95861 | CPT | Covered |
| 95863 | CPT | Covered |
| 95864 | CPT | Covered |
| 95865 | CPT | Covered |
| 95866 | CPT | Covered |
| 95867 | CPT | Covered |
| 95868 | CPT | Covered |
| 95869 | CPT | Covered |
| 95870 | CPT | Covered |
| 95872 | CPT | Covered |
| 95873 | CPT | Covered |
| 95874 | CPT | Covered |
| 95885 | CPT | Covered |
| 95886 | CPT | Covered |
| 95887 | CPT | Covered |
| 95905 | CPT | Covered |
| 95907 | CPT | Covered |
| 95908 | CPT | Covered |
| 95909 | CPT | Covered |
| 95910 | CPT | Covered |
| 95911 | CPT | Covered |
| 95912 | CPT | Covered |
| 95913 | CPT | Covered |
| 95933 | CPT | Covered |
| 95937 | CPT | Covered |
| 95999 | CPT | Covered |
| G0255 | HCPCS | Covered |
| A05.1 | ICD10CM | Covered |
| A35 | ICD10CM | Covered |
| A52.15 | ICD10CM | Covered |
| B91 | ICD10CM | Covered |
| C70.0 | ICD10CM | Covered |
| C70.1 | 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 |
| C79.31 | ICD10CM | Covered |
| C79.32 | ICD10CM | Covered |
| C79.49 | ICD10CM | Covered |
| D32.1 | ICD10CM | Covered |
| D33.3 | ICD10CM | Covered |
| D33.4 | ICD10CM | Covered |
| D33.7 | ICD10CM | Covered |
| E08.40 | ICD10CM | Covered |
| E08.41 | ICD10CM | Covered |
| E08.42 | ICD10CM | Covered |
| E08.43 | ICD10CM | Covered |
| E08.44 | ICD10CM | Covered |
| E08.49 | ICD10CM | Covered |
| E08.610 | ICD10CM | Covered |
| E09.40 | ICD10CM | Covered |
| E09.41 | ICD10CM | Covered |
| E09.42 | ICD10CM | Covered |
| E09.43 | ICD10CM | Covered |
| E09.44 | ICD10CM | Covered |
| E09.49 | ICD10CM | Covered |
| E09.610 | ICD10CM | Covered |
| E10.40 | ICD10CM | Covered |
| E10.41 | ICD10CM | Covered |
| E10.42 | ICD10CM | Covered |
| E10.43 | ICD10CM | Covered |
| E10.44 | ICD10CM | Covered |
| E10.49 | ICD10CM | Covered |
| E10.610 | ICD10CM | Covered |
| E11.10 | ICD10CM | Covered |
| E11.11 | ICD10CM | Covered |
| E11.40 | ICD10CM | Covered |
| E11.41 | ICD10CM | Covered |
| E11.42 | ICD10CM | Covered |
| E11.43 | ICD10CM | Covered |
| E11.44 | ICD10CM | Covered |
| E11.49 | ICD10CM | Covered |
| E11.610 | ICD10CM | Covered |
| E13.40 | ICD10CM | Covered |
| E13.41 | ICD10CM | Covered |
| E13.42 | ICD10CM | Covered |
| E13.43 | ICD10CM | Covered |
| E13.44 | ICD10CM | Covered |
| E13.49 | ICD10CM | Covered |
| E13.610 | ICD10CM | Covered |
| E51.2 | ICD10CM | Covered |
| E51.8 | ICD10CM | Covered |
| E51.9 | ICD10CM | Covered |
| E56.0 | ICD10CM | Covered |
| E56.8 | ICD10CM | Covered |
| E78.6 | ICD10CM | Covered |
| G04.1 | ICD10CM | Covered |
| G11.0 | ICD10CM | Covered |
| G11.10 | ICD10CM | Covered |
| G11.11 | ICD10CM | Covered |
| G11.19 | ICD10CM | Covered |
| G11.2 | ICD10CM | Covered |
| G11.3 | ICD10CM | Covered |
| G11.4 | ICD10CM | Covered |
| G11.8 | ICD10CM | Covered |
| G11.9 | ICD10CM | Covered |
| G12.0 | ICD10CM | Covered |
| G12.1 | ICD10CM | Covered |
| G12.20 | ICD10CM | Covered |
| G12.21 | ICD10CM | Covered |
| G12.22 | ICD10CM | Covered |
| G12.23 | ICD10CM | Covered |
| G12.24 | ICD10CM | Covered |
| G12.25 | ICD10CM | Covered |
| G12.29 | ICD10CM | Covered |
| G12.8 | ICD10CM | Covered |
| G12.9 | ICD10CM | Covered |
| G13.0 | ICD10CM | Covered |
| G13.1 | ICD10CM | Covered |
| G14 | ICD10CM | Covered |
| G20.C | ICD10CM | Covered |
| G21.4 | ICD10CM | Covered |
| G24.01 | ICD10CM | Covered |
| G24.02 | ICD10CM | Covered |
| G24.09 | ICD10CM | Covered |
| G24.1 | ICD10CM | Covered |
| G24.2 | ICD10CM | Covered |
| G24.3 | ICD10CM | Covered |
| G24.4 | ICD10CM | Covered |
| G24.5 | ICD10CM | Covered |
| G24.8 | ICD10CM | Covered |
| G24.9 | ICD10CM | Covered |
| G25.3 | ICD10CM | Covered |
| G25.61 | ICD10CM | Covered |
| G25.69 | ICD10CM | Covered |
| G25.89 | ICD10CM | Covered |
| G32.0 | ICD10CM | Covered |
| G32.81 | ICD10CM | Covered |
| G35.A | ICD10CM | Covered |
| G35.B0 | ICD10CM | Covered |
| G35.B1 | ICD10CM | Covered |
| G35.B2 | ICD10CM | Covered |
| G35.C0 | ICD10CM | Covered |
| G35.C1 | ICD10CM | Covered |
| G35.C2 | ICD10CM | Covered |
| G36.0 | ICD10CM | Covered |
| G36.1 | ICD10CM | Covered |
| G36.8 | ICD10CM | Covered |
| G37.0 | ICD10CM | Covered |
| G37.1 | ICD10CM | Covered |
| G37.2 | ICD10CM | Covered |
| G37.3 | ICD10CM | Covered |
| G37.4 | ICD10CM | Covered |
| G37.5 | ICD10CM | Covered |
| G37.89 | ICD10CM | Covered |
| G50.0 | ICD10CM | Covered |
| G50.1 | ICD10CM | Covered |
| G50.8 | ICD10CM | Covered |
| G51.0 | ICD10CM | Covered |
| G51.2 | ICD10CM | Covered |
| G51.31 | ICD10CM | Covered |
| G51.32 | ICD10CM | Covered |
| G51.33 | ICD10CM | Covered |
| G51.4 | ICD10CM | Covered |
| G51.8 | ICD10CM | Covered |
| G52.1 | ICD10CM | Covered |
| G52.2 | ICD10CM | Covered |
| G52.3 | ICD10CM | Covered |
| G52.7 | ICD10CM | Covered |
| G52.8 | ICD10CM | Covered |
| G53 | ICD10CM | Covered |
| G54.0 | ICD10CM | Covered |
| G54.1 | ICD10CM | Covered |
| G54.2 | ICD10CM | Covered |
| G54.3 | ICD10CM | Covered |
| G54.4 | ICD10CM | Covered |
| G54.5 | ICD10CM | Covered |
| G54.6 | ICD10CM | Covered |
| G54.7 | ICD10CM | Covered |
| G54.8 | ICD10CM | Covered |
| G55 | ICD10CM | Covered |
| G56.01 | ICD10CM | Covered |
| G56.02 | ICD10CM | Covered |
| G56.03 | ICD10CM | Covered |
| G56.11 | ICD10CM | Covered |
| G56.12 | ICD10CM | Covered |
| G56.13 | ICD10CM | Covered |
| G56.21 | ICD10CM | Covered |
| G56.22 | ICD10CM | Covered |
| G56.23 | ICD10CM | Covered |
| G56.31 | ICD10CM | Covered |
| G56.32 | ICD10CM | Covered |
| G56.33 | ICD10CM | Covered |
| G56.41 | ICD10CM | Covered |
| G56.42 | ICD10CM | Covered |
| G56.43 | ICD10CM | Covered |
| G56.81 | ICD10CM | Covered |
| G56.82 | ICD10CM | Covered |
| G56.83 | ICD10CM | Covered |
| G56.91 | ICD10CM | Covered |
| G56.92 | ICD10CM | Covered |
| G56.93 | ICD10CM | Covered |
| G57.01 | ICD10CM | Covered |
| G57.02 | ICD10CM | Covered |
| G57.03 | ICD10CM | Covered |
| G57.11 | ICD10CM | Covered |
| G57.12 | ICD10CM | Covered |
| G57.13 | ICD10CM | Covered |
| G57.21 | ICD10CM | Covered |
| G57.22 | ICD10CM | Covered |
| G57.23 | ICD10CM | Covered |
| G57.31 | ICD10CM | Covered |
| G57.32 | ICD10CM | Covered |
| G57.33 | ICD10CM | Covered |
| G57.41 | ICD10CM | Covered |
| G57.42 | ICD10CM | Covered |
| G57.43 | ICD10CM | Covered |
| G57.51 | ICD10CM | Covered |
| G57.52 | ICD10CM | Covered |
| G57.53 | ICD10CM | Covered |
| G57.61 | ICD10CM | Covered |
| G57.62 | ICD10CM | Covered |
| G57.63 | ICD10CM | Covered |
| G57.71 | ICD10CM | Covered |
| G57.72 | ICD10CM | Covered |
| G57.73 | ICD10CM | Covered |
| G57.81 | ICD10CM | Covered |
| G57.82 | ICD10CM | Covered |
| G57.83 | ICD10CM | Covered |
| G57.91 | ICD10CM | Covered |
| G57.92 | ICD10CM | Covered |
| G57.93 | ICD10CM | Covered |
| G58.0 | ICD10CM | Covered |
| G58.7 | ICD10CM | Covered |
| G58.8 | ICD10CM | Covered |
| G59 | ICD10CM | Covered |
| G60.0 | ICD10CM | Covered |
| G60.1 | ICD10CM | Covered |
| G60.2 | ICD10CM | Covered |
| G60.3 | ICD10CM | Covered |
| G60.8 | ICD10CM | Covered |
| G60.9 | ICD10CM | Covered |
| G61.0 | ICD10CM | Covered |
| G61.1 | ICD10CM | Covered |
| G61.81 | ICD10CM | Covered |
| G61.82 | ICD10CM | Covered |
| G61.89 | ICD10CM | Covered |
| G62.0 | ICD10CM | Covered |
| G62.1 | ICD10CM | Covered |
| G62.2 | ICD10CM | Covered |
| G62.81 | ICD10CM | Covered |
| G62.82 | ICD10CM | Covered |
| G62.89 | ICD10CM | Covered |
| G63 | ICD10CM | Covered |
| G64 | ICD10CM | Covered |
| G65.0 | ICD10CM | Covered |
| G65.1 | ICD10CM | Covered |
| G65.2 | ICD10CM | Covered |
| G70.00 | ICD10CM | Covered |
| G70.01 | ICD10CM | Covered |
| G70.1 | ICD10CM | Covered |
| G70.2 | ICD10CM | Covered |
| G70.80 | ICD10CM | Covered |
| G70.81 | ICD10CM | Covered |
| G70.89 | ICD10CM | Covered |
| G71.01 | ICD10CM | Covered |
| G71.02 | ICD10CM | Covered |
| G71.031 | ICD10CM | Covered |
| G71.032 | ICD10CM | Covered |
| G71.033 | ICD10CM | Covered |
| G71.0341 | ICD10CM | Covered |
| G71.0342 | ICD10CM | Covered |
| G71.0349 | ICD10CM | Covered |
| G71.035 | ICD10CM | Covered |
| G71.036 | ICD10CM | Covered |
| G71.038 | ICD10CM | Covered |
| G71.09 | ICD10CM | Covered |
| G71.11 | ICD10CM | Covered |
| G71.12 | ICD10CM | Covered |
| G71.13 | ICD10CM | Covered |
| G71.14 | ICD10CM | Covered |
| G71.19 | ICD10CM | Covered |
| G71.20 | ICD10CM | Covered |
| G71.21 | ICD10CM | Covered |
| G71.220 | ICD10CM | Covered |
| G71.228 | ICD10CM | Covered |
| G71.29 | ICD10CM | Covered |
| G71.3 | ICD10CM | Covered |
| G71.8 | ICD10CM | Covered |
| G72.0 | ICD10CM | Covered |
| G72.1 | ICD10CM | Covered |
| G72.2 | ICD10CM | Covered |
| G72.3 | ICD10CM | Covered |
| G72.41 | ICD10CM | Covered |
| G72.49 | ICD10CM | Covered |
| G72.81 | ICD10CM | Covered |
| G72.89 | ICD10CM | Covered |
| G73.1 | ICD10CM | Covered |
| G73.3 | ICD10CM | Covered |
| G73.7 | ICD10CM | Covered |
| G80.0 | ICD10CM | Covered |
| G80.1 | ICD10CM | Covered |
| G80.2 | ICD10CM | Covered |
| G80.3 | ICD10CM | Covered |
| G80.4 | ICD10CM | Covered |
| G80.8 | ICD10CM | Covered |
| G81.01 | ICD10CM | Covered |
| G81.02 | ICD10CM | Covered |
| G81.03 | ICD10CM | Covered |
| G81.04 | ICD10CM | Covered |
| G81.11 | ICD10CM | Covered |
| G81.12 | ICD10CM | Covered |
| G81.13 | ICD10CM | Covered |
| G81.14 | ICD10CM | Covered |
| G81.91 | ICD10CM | Covered |
| G81.92 | ICD10CM | Covered |
| G81.93 | ICD10CM | Covered |
| G81.94 | ICD10CM | Covered |
| G82.21 | ICD10CM | Covered |
| G82.22 | ICD10CM | Covered |
| G82.51 | ICD10CM | Covered |
| G82.52 | ICD10CM | Covered |
| G82.53 | ICD10CM | Covered |
| G82.54 | ICD10CM | Covered |
| G83.0 | ICD10CM | Covered |
| G83.11 | ICD10CM | Covered |
| G83.12 | ICD10CM | Covered |
| G83.13 | ICD10CM | Covered |
| G83.14 | ICD10CM | Covered |
| G83.21 | ICD10CM | Covered |
| G83.22 | ICD10CM | Covered |
| G83.23 | ICD10CM | Covered |
| G83.24 | ICD10CM | Covered |
| G83.31 | ICD10CM | Covered |
| G83.32 | ICD10CM | Covered |
| G83.33 | ICD10CM | Covered |
| G83.34 | ICD10CM | Covered |
| G83.4 | ICD10CM | Covered |
| G83.5 | ICD10CM | Covered |
| G83.81 | ICD10CM | Covered |
| G83.82 | ICD10CM | Covered |
| G83.83 | ICD10CM | Covered |
| G83.84 | ICD10CM | Covered |
| G83.89 | ICD10CM | Covered |
| G90.01 | ICD10CM | Covered |
| G90.09 | ICD10CM | Covered |
| G90.2 | ICD10CM | Covered |
| G90.4 | ICD10CM | Covered |
| G90.511 | ICD10CM | Covered |
| G90.512 | ICD10CM | Covered |
| G90.513 | ICD10CM | Covered |
| G90.521 | ICD10CM | Covered |
| G90.522 | ICD10CM | Covered |
| G90.523 | ICD10CM | Covered |
| G90.59 | ICD10CM | Covered |
| G93.31 | ICD10CM | Covered |
| G93.32 | ICD10CM | Covered |
| G93.39 | ICD10CM | Covered |
| G95.0 | ICD10CM | Covered |
| G95.11 | ICD10CM | Covered |
| G95.19 | ICD10CM | Covered |
| G95.29 | ICD10CM | Covered |
| G95.81 | ICD10CM | Covered |
| G95.89 | ICD10CM | Covered |
| G99.0 | ICD10CM | Covered |
| G99.2 | ICD10CM | Covered |
| H02.141 | ICD10CM | Covered |
| H02.142 | ICD10CM | Covered |
| H02.144 | ICD10CM | Covered |
| H02.145 | ICD10CM | Covered |
| H02.401 | ICD10CM | Covered |
| H02.402 | ICD10CM | Covered |
| H02.403 | ICD10CM | Covered |
| H02.421 | ICD10CM | Covered |
| H02.422 | ICD10CM | Covered |
| H02.423 | ICD10CM | Covered |
| H02.431 | ICD10CM | Covered |
| H02.432 | ICD10CM | Covered |
| H02.433 | ICD10CM | Covered |
| H49.01 | ICD10CM | Covered |
| H49.02 | ICD10CM | Covered |
| H49.03 | ICD10CM | Covered |
| H49.11 | ICD10CM | Covered |
| H49.12 | ICD10CM | Covered |
| H49.13 | ICD10CM | Covered |
| H49.21 | ICD10CM | Covered |
| H49.22 | ICD10CM | Covered |
| H49.23 | ICD10CM | Covered |
| H49.31 | ICD10CM | Covered |
| H49.32 | ICD10CM | Covered |
| H49.33 | ICD10CM | Covered |
| H49.41 | ICD10CM | Covered |
| H49.42 | ICD10CM | Covered |
| H49.43 | ICD10CM | Covered |
| H49.881 | ICD10CM | Covered |
| H49.882 | ICD10CM | Covered |
| H49.883 | ICD10CM | Covered |
| H50.011 | ICD10CM | Covered |
| H50.012 | ICD10CM | Covered |
| H50.021 | ICD10CM | Covered |
| H50.022 | ICD10CM | Covered |
| H50.031 | ICD10CM | Covered |
| H50.032 | ICD10CM | Covered |
| H50.041 | ICD10CM | Covered |
| H50.042 | ICD10CM | Covered |
| H50.05 | ICD10CM | Covered |
| H50.06 | ICD10CM | Covered |
| H50.07 | ICD10CM | Covered |
| H50.08 | ICD10CM | Covered |
| H50.10 | ICD10CM | Covered |
| H50.111 | ICD10CM | Covered |
| H50.112 | ICD10CM | Covered |
| H50.121 | ICD10CM | Covered |
| H50.122 | ICD10CM | Covered |
| H50.131 | ICD10CM | Covered |
| H50.132 | ICD10CM | Covered |
| H50.141 | ICD10CM | Covered |
| H50.142 | ICD10CM | Covered |
| H50.15 | ICD10CM | Covered |
| H50.16 | ICD10CM | Covered |
| H50.17 | ICD10CM | Covered |
| H50.18 | ICD10CM | Covered |
| H50.21 | ICD10CM | Covered |
| H50.22 | ICD10CM | Covered |
| H50.311 | ICD10CM | Covered |
| H50.312 | ICD10CM | Covered |
| H50.32 | ICD10CM | Covered |
| H50.331 | ICD10CM | Covered |
| H50.332 | ICD10CM | Covered |
| H50.34 | ICD10CM | Covered |
| H50.40 | ICD10CM | Covered |
| H50.411 | ICD10CM | Covered |
| H50.412 | ICD10CM | Covered |
| H50.42 | ICD10CM | Covered |
| H50.43 | ICD10CM | Covered |
| H50.50 | ICD10CM | Covered |
| H50.51 | ICD10CM | Covered |
| H50.52 | ICD10CM | Covered |
| H50.53 | ICD10CM | Covered |
| H50.54 | ICD10CM | Covered |
| H50.55 | ICD10CM | Covered |
| H50.611 | ICD10CM | Covered |
| H50.612 | ICD10CM | Covered |
| H50.621 | ICD10CM | Covered |
| H50.622 | ICD10CM | Covered |
| H50.631 | ICD10CM | Covered |
| H50.632 | ICD10CM | Covered |
| H50.641 | ICD10CM | Covered |
| H50.642 | ICD10CM | Covered |
| H50.651 | ICD10CM | Covered |
| H50.652 | ICD10CM | Covered |
| H50.661 | ICD10CM | Covered |
| H50.662 | ICD10CM | Covered |
| H50.671 | ICD10CM | Covered |
| H50.672 | ICD10CM | Covered |
| H50.69 | ICD10CM | Covered |
| H50.811 | ICD10CM | Covered |
| H50.812 | ICD10CM | Covered |
| H50.89 | ICD10CM | Covered |
| H51.0 | ICD10CM | Covered |
| H51.11 | ICD10CM | Covered |
| H51.12 | ICD10CM | Covered |
| H51.21 | ICD10CM | Covered |
| H51.22 | ICD10CM | Covered |
| H51.23 | ICD10CM | Covered |
| H51.8 | ICD10CM | Covered |
| H53.2 | ICD10CM | Covered |
| I95.1 | ICD10CM | Covered |
| J38.01 | ICD10CM | Covered |
| J38.02 | ICD10CM | Covered |
| J38.5 | ICD10CM | Covered |
| J38.7 | ICD10CM | Covered |
| K22.0 | ICD10CM | Covered |
| M05.411 | ICD10CM | Covered |
| M05.412 | ICD10CM | Covered |
| M05.421 | ICD10CM | Covered |
| M05.422 | ICD10CM | Covered |
| M05.431 | ICD10CM | Covered |
| M05.432 | ICD10CM | Covered |
| M05.441 | ICD10CM | Covered |
| M05.442 | ICD10CM | Covered |
| M05.451 | ICD10CM | Covered |
| M05.452 | ICD10CM | Covered |
| M05.461 | ICD10CM | Covered |
| M05.462 | ICD10CM | Covered |
| M05.471 | ICD10CM | Covered |
| M05.472 | ICD10CM | Covered |
| M05.49 | ICD10CM | Covered |
| M05.511 | ICD10CM | Covered |
| M05.512 | ICD10CM | Covered |
| M05.521 | ICD10CM | Covered |
| M05.522 | ICD10CM | Covered |
| M05.531 | ICD10CM | Covered |
| M05.532 | ICD10CM | Covered |
| M05.541 | ICD10CM | Covered |
| M05.542 | ICD10CM | Covered |
| M05.551 | ICD10CM | Covered |
| M05.552 | ICD10CM | Covered |
| M05.561 | ICD10CM | Covered |
| M05.562 | ICD10CM | Covered |
| M05.571 | ICD10CM | Covered |
| M05.572 | ICD10CM | Covered |
| M05.59 | ICD10CM | Covered |
| M05.7A | ICD10CM | Covered |
| M05.8A | ICD10CM | Covered |
| M06.0A | ICD10CM | Covered |
| M06.8A | ICD10CM | Covered |
| M08.0A | ICD10CM | Covered |
| M08.2A | ICD10CM | Covered |
| M08.4A | ICD10CM | Covered |
| M08.9A | ICD10CM | Covered |
| M21.071 | ICD10CM | Covered |
| M21.072 | ICD10CM | Covered |
| M21.171 | ICD10CM | Covered |
| M21.172 | ICD10CM | Covered |
| M21.331 | ICD10CM | Covered |
| M21.332 | ICD10CM | Covered |
| M21.371 | ICD10CM | Covered |
| M21.372 | ICD10CM | Covered |
| M21.511 | ICD10CM | Covered |
| M21.512 | ICD10CM | Covered |
| M21.531 | ICD10CM | Covered |
| M21.532 | ICD10CM | Covered |
| M21.541 | ICD10CM | Covered |
| M21.542 | ICD10CM | Covered |
| M21.6X1 | ICD10CM | Covered |
| M21.6X2 | ICD10CM | Covered |
| M21.831 | ICD10CM | Covered |
| M21.832 | ICD10CM | Covered |
| M33.01 | ICD10CM | Covered |
| M33.02 | ICD10CM | Covered |
| M33.03 | ICD10CM | Covered |
| M33.09 | ICD10CM | Covered |
| M33.11 | ICD10CM | Covered |
| M33.12 | ICD10CM | Covered |
| M33.13 | ICD10CM | Covered |
| M33.19 | ICD10CM | Covered |
| M33.21 | ICD10CM | Covered |
| M33.22 | ICD10CM | Covered |
| M33.29 | ICD10CM | Covered |
| M33.91 | ICD10CM | Covered |
| M33.92 | ICD10CM | Covered |
| M33.93 | ICD10CM | Covered |
| M33.99 | ICD10CM | Covered |
| M34.82 | ICD10CM | Covered |
| M34.83 | ICD10CM | Covered |
| M35.03 | ICD10CM | Covered |
| M35.05 | ICD10CM | Covered |
| M35.06 | ICD10CM | Covered |
| M35.07 | ICD10CM | Covered |
| M35.08 | ICD10CM | Covered |
| M35.0A | ICD10CM | Covered |
| M35.0B | ICD10CM | Covered |
| M35.0C | ICD10CM | Covered |
| M35.3 | ICD10CM | Covered |
| M35.4 | ICD10CM | Covered |
| M35.81 | ICD10CM | Covered |
| M35.89 | ICD10CM | Covered |
| M36.0 | ICD10CM | Covered |
| M43.01 | ICD10CM | Covered |
| M43.02 | ICD10CM | Covered |
| M43.03 | ICD10CM | Covered |
| M43.04 | ICD10CM | Covered |
| M43.05 | ICD10CM | Covered |
| M43.06 | ICD10CM | Covered |
| M43.07 | ICD10CM | Covered |
| M43.08 | ICD10CM | Covered |
| M43.09 | ICD10CM | Covered |
| M43.11 | ICD10CM | Covered |
| M43.12 | ICD10CM | Covered |
| M43.13 | ICD10CM | Covered |
| M43.14 | ICD10CM | Covered |
| M43.15 | ICD10CM | Covered |
| M43.16 | ICD10CM | Covered |
| M43.17 | ICD10CM | Covered |
| M43.18 | ICD10CM | Covered |
| M43.19 | ICD10CM | Covered |
| M43.6 | ICD10CM | Covered |
| M46.41 | ICD10CM | Covered |
| M46.42 | ICD10CM | Covered |
| M46.43 | ICD10CM | Covered |
| M46.44 | ICD10CM | Covered |
| M46.45 | ICD10CM | Covered |
| M46.46 | ICD10CM | Covered |
| M46.47 | ICD10CM | Covered |
| M47.011 | ICD10CM | Covered |
| M47.012 | ICD10CM | Covered |
| M47.013 | ICD10CM | Covered |
| M47.014 | ICD10CM | Covered |
| M47.015 | ICD10CM | Covered |
| M47.016 | ICD10CM | Covered |
| M47.021 | ICD10CM | Covered |
| M47.022 | ICD10CM | Covered |
| M47.11 | ICD10CM | Covered |
| M47.12 | ICD10CM | Covered |
| M47.13 | ICD10CM | Covered |
| M47.14 | ICD10CM | Covered |
| M47.15 | ICD10CM | Covered |
| M47.16 | ICD10CM | Covered |
| M47.21 | ICD10CM | Covered |
| M47.22 | ICD10CM | Covered |
| M47.23 | ICD10CM | Covered |
| M47.24 | ICD10CM | Covered |
| M47.25 | ICD10CM | Covered |
| M47.26 | ICD10CM | Covered |
| M47.27 | ICD10CM | Covered |
| M47.28 | ICD10CM | Covered |
| M47.811 | ICD10CM | Covered |
| M47.812 | ICD10CM | Covered |
| M47.813 | ICD10CM | Covered |
| M47.814 | ICD10CM | Covered |
| M47.815 | ICD10CM | Covered |
| M47.816 | ICD10CM | Covered |
| M47.817 | ICD10CM | Covered |
| M47.818 | ICD10CM | Covered |
| M48.01 | ICD10CM | Covered |
| M48.02 | ICD10CM | Covered |
| M48.03 | ICD10CM | Covered |
| M48.04 | ICD10CM | Covered |
| M48.05 | ICD10CM | Covered |
| M48.061 | ICD10CM | Covered |
| M48.062 | ICD10CM | Covered |
| M48.07 | ICD10CM | Covered |
| M48.08 | ICD10CM | Covered |
| M48.11 | ICD10CM | Covered |
| M48.12 | ICD10CM | Covered |
| M48.13 | ICD10CM | Covered |
| M48.14 | ICD10CM | Covered |
| M48.15 | ICD10CM | Covered |
| M48.16 | ICD10CM | Covered |
| M48.17 | ICD10CM | Covered |
| M48.18 | ICD10CM | Covered |
| M48.19 | ICD10CM | Covered |
| M48.21 | ICD10CM | Covered |
| M48.22 | ICD10CM | Covered |
| M48.23 | ICD10CM | Covered |
| M48.24 | ICD10CM | Covered |
| M48.25 | ICD10CM | Covered |
| M48.26 | ICD10CM | Covered |
| M48.27 | ICD10CM | Covered |
| M48.31 | ICD10CM | Covered |
| M48.32 | ICD10CM | Covered |
| M48.33 | ICD10CM | Covered |
| M48.34 | ICD10CM | Covered |
| M48.35 | ICD10CM | Covered |
| M48.36 | ICD10CM | Covered |
| M48.37 | ICD10CM | Covered |
| M48.38 | ICD10CM | Covered |
| M50.01 | ICD10CM | Covered |
| M50.021 | ICD10CM | Covered |
| M50.022 | ICD10CM | Covered |
| M50.023 | ICD10CM | Covered |
| M50.03 | ICD10CM | Covered |
| M50.11 | ICD10CM | Covered |
| M50.121 | ICD10CM | Covered |
| M50.122 | ICD10CM | Covered |
| M50.123 | ICD10CM | Covered |
| M50.13 | ICD10CM | Covered |
| M50.21 | ICD10CM | Covered |
| M50.221 | ICD10CM | Covered |
| M50.222 | ICD10CM | Covered |
| M50.223 | ICD10CM | Covered |
| M50.23 | ICD10CM | Covered |
| M50.31 | ICD10CM | Covered |
| M50.321 | ICD10CM | Covered |
| M50.322 | ICD10CM | Covered |
| M50.323 | ICD10CM | Covered |
| M50.33 | ICD10CM | Covered |
| M50.81 | ICD10CM | Covered |
| M50.821 | ICD10CM | Covered |
| M50.822 | ICD10CM | Covered |
| M50.823 | ICD10CM | Covered |
| M50.83 | ICD10CM | Covered |
| M51.04 | ICD10CM | Covered |
| M51.05 | ICD10CM | Covered |
| M51.06 | ICD10CM | Covered |
| M51.14 | ICD10CM | Covered |
| M51.15 | ICD10CM | Covered |
| M51.16 | ICD10CM | Covered |
| M51.17 | ICD10CM | Covered |
| M51.24 | ICD10CM | Covered |
| M51.25 | ICD10CM | Covered |
| M51.26 | ICD10CM | Covered |
| M51.27 | ICD10CM | Covered |
| M51.34 | ICD10CM | Covered |
| M51.35 | ICD10CM | Covered |
| M51.361 | ICD10CM | Covered |
| M51.362 | ICD10CM | Covered |
| M51.371 | ICD10CM | Covered |
| M51.44 | ICD10CM | Covered |
| M51.45 | ICD10CM | Covered |
| M51.46 | ICD10CM | Covered |
| M51.47 | ICD10CM | Covered |
| M51.84 | ICD10CM | Covered |
| M51.85 | ICD10CM | Covered |
| M51.86 | ICD10CM | Covered |
| M51.87 | ICD10CM | Covered |
| M53.82 | ICD10CM | Covered |
| M54.11 | ICD10CM | Covered |
| M54.12 | ICD10CM | Covered |
| M54.13 | ICD10CM | Covered |
| M54.14 | ICD10CM | Covered |
| M54.15 | ICD10CM | Covered |
| M54.16 | ICD10CM | Covered |
| M54.17 | ICD10CM | Covered |
| M54.18 | ICD10CM | Covered |
| M54.2 | ICD10CM | Covered |
| M54.31 | ICD10CM | Covered |
| M54.32 | ICD10CM | Covered |
| M54.41 | ICD10CM | Covered |
| M54.42 | ICD10CM | Covered |
| M54.6 | ICD10CM | Covered |
| M54.89 | ICD10CM | Covered |
| M60.000 | ICD10CM | Covered |
| M60.001 | ICD10CM | Covered |
| M60.003 | ICD10CM | Covered |
| M60.004 | ICD10CM | Covered |
| M60.011 | ICD10CM | Covered |
| M60.012 | ICD10CM | Covered |
| M60.021 | ICD10CM | Covered |
| M60.022 | ICD10CM | Covered |
| M60.031 | ICD10CM | Covered |
| M60.032 | ICD10CM | Covered |
| M60.041 | ICD10CM | Covered |
| M60.042 | ICD10CM | Covered |
| M60.044 | ICD10CM | Covered |
| M60.045 | ICD10CM | Covered |
| M60.051 | ICD10CM | Covered |
| M60.052 | ICD10CM | Covered |
| M60.061 | ICD10CM | Covered |
| M60.062 | ICD10CM | Covered |
| M60.070 | ICD10CM | Covered |
| M60.071 | ICD10CM | Covered |
| M60.073 | ICD10CM | Covered |
| M60.074 | ICD10CM | Covered |
| M60.076 | ICD10CM | Covered |
| M60.077 | ICD10CM | Covered |
| M60.08 | ICD10CM | Covered |
| M60.09 | ICD10CM | Covered |
| M60.811 | ICD10CM | Covered |
| M60.812 | ICD10CM | Covered |
| M60.821 | ICD10CM | Covered |
| M60.822 | ICD10CM | Covered |
| M60.831 | ICD10CM | Covered |
| M60.832 | ICD10CM | Covered |
| M60.841 | ICD10CM | Covered |
| M60.842 | ICD10CM | Covered |
| M60.851 | ICD10CM | Covered |
| M60.852 | ICD10CM | Covered |
| M60.861 | ICD10CM | Covered |
| M60.862 | ICD10CM | Covered |
| M60.871 | ICD10CM | Covered |
| M60.872 | ICD10CM | Covered |
| M60.88 | ICD10CM | Covered |
| M60.89 | ICD10CM | Covered |
| M62.211 | ICD10CM | Covered |
| M62.212 | ICD10CM | Covered |
| M62.221 | ICD10CM | Covered |
| M62.222 | ICD10CM | Covered |
| M62.231 | ICD10CM | Covered |
| M62.232 | ICD10CM | Covered |
| M62.241 | ICD10CM | Covered |
| M62.242 | ICD10CM | Covered |
| M62.251 | ICD10CM | Covered |
| M62.252 | ICD10CM | Covered |
| M62.261 | ICD10CM | Covered |
| M62.262 | ICD10CM | Covered |
| M62.271 | ICD10CM | Covered |
| M62.272 | ICD10CM | Covered |
| M62.411 | ICD10CM | Covered |
| M62.412 | ICD10CM | Covered |
| M62.421 | ICD10CM | Covered |
| M62.422 | ICD10CM | Covered |
| M62.431 | ICD10CM | Covered |
| M62.432 | ICD10CM | Covered |
| M62.441 | ICD10CM | Covered |
| M62.442 | ICD10CM | Covered |
| M62.451 | ICD10CM | Covered |
| M62.452 | ICD10CM | Covered |
| M62.461 | ICD10CM | Covered |
| M62.462 | ICD10CM | Covered |
| M62.471 | ICD10CM | Covered |
| M62.472 | ICD10CM | Covered |
| M62.48 | ICD10CM | Covered |
| M62.49 | ICD10CM | Covered |
| M62.511 | ICD10CM | Covered |
| M62.512 | ICD10CM | Covered |
| M62.521 | ICD10CM | Covered |
| M62.522 | ICD10CM | Covered |
| M62.531 | ICD10CM | Covered |
| M62.532 | ICD10CM | Covered |
| M62.541 | ICD10CM | Covered |
| M62.542 | ICD10CM | Covered |
| M62.551 | ICD10CM | Covered |
| M62.552 | ICD10CM | Covered |
| M62.561 | ICD10CM | Covered |
| M62.562 | ICD10CM | Covered |
| M62.571 | ICD10CM | Covered |
| M62.572 | ICD10CM | Covered |
| M62.58 | ICD10CM | Covered |
| M62.59 | ICD10CM | Covered |
| M62.5A0 | ICD10CM | Covered |
| M62.5A1 | ICD10CM | Covered |
| M62.5A2 | ICD10CM | Covered |
| M62.81 | ICD10CM | Covered |
| M62.82 | ICD10CM | Covered |
| M62.831 | ICD10CM | Covered |
| M62.89 | ICD10CM | Covered |
| M63.811 | ICD10CM | Covered |
| M63.812 | ICD10CM | Covered |
| M63.821 | ICD10CM | Covered |
| M63.822 | ICD10CM | Covered |
| M63.831 | ICD10CM | Covered |
| M63.832 | ICD10CM | Covered |
| M63.841 | ICD10CM | Covered |
| M63.842 | ICD10CM | Covered |
| M63.851 | ICD10CM | Covered |
| M63.852 | ICD10CM | Covered |
| M63.861 | ICD10CM | Covered |
| M63.862 | ICD10CM | Covered |
| M63.871 | ICD10CM | Covered |
| M63.872 | ICD10CM | Covered |
| M63.88 | ICD10CM | Covered |
| M63.89 | ICD10CM | Covered |
| M72.8 | ICD10CM | Covered |
| M79.11 | ICD10CM | Covered |
| M79.12 | ICD10CM | Covered |
| M79.18 | ICD10CM | Covered |
| M79.601 | ICD10CM | Covered |
| M79.602 | ICD10CM | Covered |
| M79.604 | ICD10CM | Covered |
| M79.605 | ICD10CM | Covered |
| M79.621 | ICD10CM | Covered |
| M79.622 | ICD10CM | Covered |
| M79.631 | ICD10CM | Covered |
| M79.632 | ICD10CM | Covered |
| M79.641 | ICD10CM | Covered |
| M79.642 | ICD10CM | Covered |
| M79.644 | ICD10CM | Covered |
| M79.645 | ICD10CM | Covered |
| M79.651 | ICD10CM | Covered |
| M79.652 | ICD10CM | Covered |
| M79.661 | ICD10CM | Covered |
| M79.662 | ICD10CM | Covered |
| M79.671 | ICD10CM | Covered |
| M79.672 | ICD10CM | Covered |
| M79.674 | ICD10CM | Covered |
| M79.675 | ICD10CM | Covered |
| M79.7 | ICD10CM | Covered |
| M96.1 | ICD10CM | Covered |
| M99.20 | ICD10CM | Covered |
| M99.21 | ICD10CM | Covered |
| M99.22 | ICD10CM | Covered |
| M99.23 | ICD10CM | Covered |
| M99.24 | ICD10CM | Covered |
| M99.25 | ICD10CM | Covered |
| M99.26 | ICD10CM | Covered |
| M99.27 | ICD10CM | Covered |
| M99.28 | ICD10CM | Covered |
| M99.29 | ICD10CM | Covered |
| M99.30 | ICD10CM | Covered |
| M99.31 | ICD10CM | Covered |
| M99.32 | ICD10CM | Covered |
| M99.33 | ICD10CM | Covered |
| M99.34 | ICD10CM | Covered |
| M99.35 | ICD10CM | Covered |
| M99.36 | ICD10CM | Covered |
| M99.37 | ICD10CM | Covered |
| M99.38 | ICD10CM | Covered |
| M99.39 | ICD10CM | Covered |
| M99.40 | ICD10CM | Covered |
| M99.41 | ICD10CM | Covered |
| M99.42 | ICD10CM | Covered |
| M99.43 | ICD10CM | Covered |
| M99.44 | ICD10CM | Covered |
| M99.45 | ICD10CM | Covered |
| M99.46 | ICD10CM | Covered |
| M99.47 | ICD10CM | Covered |
| M99.48 | ICD10CM | Covered |
| M99.49 | ICD10CM | Covered |
| M99.50 | ICD10CM | Covered |
| M99.51 | ICD10CM | Covered |
| M99.52 | ICD10CM | Covered |
| M99.53 | ICD10CM | Covered |
| M99.54 | ICD10CM | Covered |
| M99.55 | ICD10CM | Covered |
| M99.56 | ICD10CM | Covered |
| M99.57 | ICD10CM | Covered |
| M99.58 | ICD10CM | Covered |
| M99.59 | ICD10CM | Covered |
| M99.60 | ICD10CM | Covered |
| M99.61 | ICD10CM | Covered |
| M99.62 | ICD10CM | Covered |
| M99.63 | ICD10CM | Covered |
| M99.64 | ICD10CM | Covered |
| M99.65 | ICD10CM | Covered |
| M99.66 | ICD10CM | Covered |
| M99.67 | ICD10CM | Covered |
| M99.68 | ICD10CM | Covered |
| M99.69 | ICD10CM | Covered |
| M99.70 | ICD10CM | Covered |
| M99.71 | ICD10CM | Covered |
| M99.72 | ICD10CM | Covered |
| M99.73 | ICD10CM | Covered |
| M99.74 | ICD10CM | Covered |
| M99.75 | ICD10CM | Covered |
| M99.76 | ICD10CM | Covered |
| M99.77 | ICD10CM | Covered |
| M99.78 | ICD10CM | Covered |
| M99.79 | ICD10CM | Covered |
| N39.3 | ICD10CM | Covered |
| N39.41 | ICD10CM | Covered |
| N39.42 | ICD10CM | Covered |
| N39.43 | ICD10CM | Covered |
| N39.44 | ICD10CM | Covered |
| N39.45 | ICD10CM | Covered |
| N39.46 | ICD10CM | Covered |
| N39.490 | ICD10CM | Covered |
| N39.498 | ICD10CM | Covered |
| Q05.0 | ICD10CM | Covered |
| Q05.1 | ICD10CM | Covered |
| Q05.2 | ICD10CM | Covered |
| Q05.3 | ICD10CM | Covered |
| Q05.5 | ICD10CM | Covered |
| Q05.6 | ICD10CM | Covered |
| Q05.7 | ICD10CM | Covered |
| Q05.8 | ICD10CM | Covered |
| Q06.2 | ICD10CM | Covered |
| Q07.00 | ICD10CM | Covered |
| Q07.01 | ICD10CM | Covered |
| Q07.02 | ICD10CM | Covered |
| Q07.03 | ICD10CM | Covered |
| Q68.0 | ICD10CM | Covered |
| Q85.01 | ICD10CM | Covered |
| Q85.02 | ICD10CM | Covered |
| Q85.03 | ICD10CM | Covered |
| Q85.09 | ICD10CM | Covered |
| R15.0 | ICD10CM | Covered |
| R15.1 | ICD10CM | Covered |
| R15.2 | ICD10CM | Covered |
| R15.9 | ICD10CM | Covered |
| R20.0 | ICD10CM | Covered |
| R20.1 | ICD10CM | Covered |
| R20.2 | ICD10CM | Covered |
| R20.3 | ICD10CM | Covered |
| R20.8 | ICD10CM | Covered |
| R25.0 | ICD10CM | Covered |
| R25.1 | ICD10CM | Covered |
| R25.2 | ICD10CM | Covered |
| R25.3 | ICD10CM | Covered |
| R25.8 | ICD10CM | Covered |
| R26.0 | ICD10CM | Covered |
| R26.1 | ICD10CM | Covered |
| R26.81 | ICD10CM | Covered |
| R26.89 | ICD10CM | Covered |
| R27.0 | ICD10CM | Covered |
| R27.8 | ICD10CM | Covered |
| R27.9 | ICD10CM | Covered |
| R29.0 | ICD10CM | Covered |
| R29.5 | ICD10CM | Covered |
| R29.898 | ICD10CM | Covered |
| R32 | ICD10CM | Covered |
| R39.14 | ICD10CM | Covered |
| R41.1 | ICD10CM | Covered |
| R41.2 | ICD10CM | Covered |
| R41.3 | ICD10CM | Covered |
| R41.9 | ICD10CM | Covered |
| R45.83 | ICD10CM | Covered |
| R45.84 | ICD10CM | Covered |
| R45.88 | ICD10CM | Covered |
| R47.02 | ICD10CM | Covered |
| R47.1 | ICD10CM | Covered |
| R47.81 | ICD10CM | Covered |
| R47.82 | ICD10CM | Covered |
| R47.89 | ICD10CM | Covered |
| R49.0 | ICD10CM | Covered |
| R49.1 | ICD10CM | Covered |
| R49.21 | ICD10CM | Covered |
| R49.22 | ICD10CM | Covered |
| R49.8 | ICD10CM | Covered |
| R53.0 | ICD10CM | Covered |
| R53.1 | ICD10CM | Covered |
| R53.81 | ICD10CM | Covered |
| R53.83 | ICD10CM | Covered |
| R68.81 | ICD10CM | Covered |
| R94.131 | ICD10CM | Covered |
| S04.51XA | ICD10CM | Covered |
| S04.52XA | ICD10CM | Covered |
| S04.811A | ICD10CM | Covered |
| S04.812A | ICD10CM | Covered |
| S04.891A | ICD10CM | Covered |
| S04.892A | ICD10CM | Covered |
| S14.0XXA | ICD10CM | Covered |
| S14.101A | ICD10CM | Covered |
| S14.102A | ICD10CM | Covered |
| S14.103A | ICD10CM | Covered |
| S14.104A | ICD10CM | Covered |
| S14.105A | ICD10CM | Covered |
| S14.106A | ICD10CM | Covered |
| S14.107A | ICD10CM | Covered |
| S14.108A | ICD10CM | Covered |