Ambetter · PayerPolicy · AMBETTER-CP-VP-06
Summary of the payer’s published policy. Not a coverage determination — confirm with Ambetter before submitting.
Free account. Policy pages stay open to everyone.
Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.
| Code | Code system | Status in this policy |
|---|---|---|
| 92071 | CPT | Covered |
| 92072 | CPT | Covered |
| 92310 | CPT | Covered |
| 92311 | CPT | Covered |
| 92312 | CPT | Covered |
| 92313 | CPT | Covered |
| 92314 | CPT | Covered |
| 92315 | CPT | Covered |
| 92316 | CPT | Covered |
| 92317 | CPT | Covered |
| 92325 | CPT | Covered |
| 92326 | CPT | Covered |
| 92340 | CPT | Covered |
| 92341 | CPT | Covered |
| 92342 | CPT | Covered |
| 92370 | CPT | Covered |
| S0500 | HCPCS | Covered |
| S0504 | HCPCS | Covered |
| S0506 | HCPCS | Covered |
| S0508 | HCPCS | Covered |
| S0510 | HCPCS | Covered |
| S0512 | HCPCS | Covered |
| S0514 | HCPCS | Covered |
| S0515 | HCPCS | Covered |
| S0516 | HCPCS | Covered |
| S0518 | HCPCS | Covered |
| S0580 | HCPCS | Covered |
| S0581 | HCPCS | Covered |
| S0592 | HCPCS | Covered |
| V2020 | HCPCS | Covered |
| V2025 | HCPCS | Covered |
| V2100 | HCPCS | Covered |
| V2101 | HCPCS | Covered |
| V2102 | HCPCS | Covered |
| V2103 | HCPCS | Covered |
| V2104 | HCPCS | Covered |
| V2105 | HCPCS | Covered |
| V2106 | HCPCS | Covered |
| V2107 | HCPCS | Covered |
| V2108 | HCPCS | Covered |
| V2109 | HCPCS | Covered |
| V2110 | HCPCS | Covered |
| V2111 | HCPCS | Covered |
| V2112 | HCPCS | Covered |
| V2113 | HCPCS | Covered |
| V2114 | HCPCS | Covered |
| V2115 | HCPCS | Covered |
| V2118 | HCPCS | Covered |
| V2121 | HCPCS | Covered |
| V2199 | HCPCS | Covered |
| V2200 | HCPCS | Covered |
| V2201 | HCPCS | Covered |
| V2202 | HCPCS | Covered |
| V2203 | HCPCS | Covered |
| V2204 | HCPCS | Covered |
| V2205 | HCPCS | Covered |
| V2206 | HCPCS | Covered |
| V2207 | HCPCS | Covered |
| V2208 | HCPCS | Covered |
| V2209 | HCPCS | Covered |
| V2210 | HCPCS | Covered |
| V2211 | HCPCS | Covered |
| V2212 | HCPCS | Covered |
| V2213 | HCPCS | Covered |
| V2214 | HCPCS | Covered |
| V2215 | HCPCS | Covered |
| V2218 | HCPCS | Covered |
| V2219 | HCPCS | Covered |
| V2220 | HCPCS | Covered |
| V2221 | HCPCS | Covered |
| V2299 | HCPCS | Covered |
| V2300 | HCPCS | Covered |
| V2301 | HCPCS | Covered |
| V2302 | HCPCS | Covered |
| V2303 | HCPCS | Covered |
| V2304 | HCPCS | Covered |
| V2305 | HCPCS | Covered |
| V2306 | HCPCS | Covered |
| V2307 | HCPCS | Covered |
| V2308 | HCPCS | Covered |
| V2309 | HCPCS | Covered |
| V2310 | HCPCS | Covered |
| V2311 | HCPCS | Covered |
| V2312 | HCPCS | Covered |
| V2313 | HCPCS | Covered |
| V2314 | HCPCS | Covered |
| V2315 | HCPCS | Covered |
| V2318 | HCPCS | Covered |
| V2319 | HCPCS | Covered |
| V2320 | HCPCS | Covered |
| V2321 | HCPCS | Covered |
| V2399 | HCPCS | Covered |
| V2410 | HCPCS | Covered |
| V2430 | HCPCS | Covered |
| V2499 | HCPCS | Covered |
| V2500 | HCPCS | Covered |
| V2501 | HCPCS | Covered |
| V2502 | HCPCS | Covered |
| V2503 | HCPCS | Covered |
| V2510 | HCPCS | Covered |
| V2511 | HCPCS | Covered |
| V2512 | HCPCS | Covered |
| V2513 | HCPCS | Covered |
| V2520 | HCPCS | Covered |
| V2521 | HCPCS | Covered |
| V2522 | HCPCS | Covered |
| V2523 | HCPCS | Covered |
| V2524 | HCPCS | Covered |
| V2525 | HCPCS | Covered |
| V2526 | HCPCS | Covered |
| V2530 | HCPCS | Covered |
| V2531 | HCPCS | Covered |
| V2599 | HCPCS | Covered |
| V2700 | HCPCS | Covered |
| V2702 | HCPCS | Covered |
| V2710 | HCPCS | Covered |
| V2715 | HCPCS | Covered |
| V2718 | HCPCS | Covered |
| V2730 | HCPCS | Covered |
| V2744 | HCPCS | Covered |
| V2745 | HCPCS | Covered |
| V2750 | HCPCS | Covered |
| V2755 | HCPCS | Covered |
| V2760 | HCPCS | Covered |
| V2761 | HCPCS | Covered |
| V2762 | HCPCS | Covered |
| V2770 | HCPCS | Covered |
| V2780 | HCPCS | Covered |
| V2781 | HCPCS | Covered |
| V2782 | HCPCS | Covered |
| V2783 | HCPCS | Covered |
| V2784 | HCPCS | Covered |
| V2786 | HCPCS | Covered |
| E70.30-E70.39 | ICD10CM | Covered |
| F84.0 | ICD10CM | Covered |
| F84.3 | ICD10CM | Covered |
| F84.5 | ICD10CM | Covered |
| F84.8 | ICD10CM | Covered |
| F84.9 | ICD10CM | Covered |
| F95.1 | ICD10CM | Covered |
| G20 | ICD10CM | Covered |
| G20. | ICD10CM | Covered |
| G21.11 | ICD10CM | Covered |
| G21.19 | ICD10CM | Covered |
| G21.3 | ICD10CM | Covered |
| G21.4 | ICD10CM | Covered |
| G21.8 | ICD10CM | Covered |
| G31.83 | ICD10CM | Covered |
| G31.84 | ICD10CM | Covered |
| G35 | ICD10CM | Covered |
| G35. | ICD10CM | Covered |
| G40.001 | ICD10CM | Covered |
| G40.009 | ICD10CM | Covered |
| G40.011 | ICD10CM | Covered |
| G40.019 | ICD10CM | Covered |
| G40.101 | ICD10CM | Covered |
| G40.109 | ICD10CM | Covered |
| G40.111 | ICD10CM | Covered |
| G40.119 | ICD10CM | Covered |
| G40.201 | ICD10CM | Covered |
| G40.209 | ICD10CM | Covered |
| G40.211 | ICD10CM | Covered |
| G40.219 | ICD10CM | Covered |
| G40.301 | ICD10CM | Covered |
| G40.309 | ICD10CM | Covered |
| G40.311 | ICD10CM | Covered |
| G40.319 | ICD10CM | Covered |
| G40.401 | ICD10CM | Covered |
| G40.409 | ICD10CM | Covered |
| G40.411 | ICD10CM | Covered |
| G40.419 | ICD10CM | Covered |
| G40.501 | ICD10CM | Covered |
| G40.509 | ICD10CM | Covered |
| G40.801 | ICD10CM | Covered |
| G40.802 | ICD10CM | Covered |
| G40.803 | ICD10CM | Covered |
| G40.804 | ICD10CM | Covered |
| G40.813 | ICD10CM | Covered |
| G40.89 | ICD10CM | Covered |
| G40.901 | ICD10CM | Covered |
| G40.909 | ICD10CM | Covered |
| G40.911 | ICD10CM | Covered |
| G40.919 | ICD10CM | Covered |
| G40.A01 | ICD10CM | Covered |
| G40.A09 | ICD10CM | Covered |
| G40.A11 | ICD10CM | Covered |
| G40.A19 | ICD10CM | Covered |
| G40.B01 | ICD10CM | Covered |
| G40.B09 | ICD10CM | Covered |
| G40.B11 | ICD10CM | Covered |
| G40.B19 | ICD10CM | Covered |
| G51.0 | ICD10CM | Covered |
| G71.0 | ICD10CM | Covered |
| G71.11 | ICD10CM | Covered |
| G71.12 | ICD10CM | Covered |
| G71.13 | ICD10CM | Covered |
| G71.14 | ICD10CM | Covered |
| G71.19 | ICD10CM | Covered |
| G71.2 | ICD10CM | Covered |
| G71.3 | ICD10CM | Covered |
| G71.8 | ICD10CM | Covered |
| G72.0 | 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 |
| G72.9 | ICD10CM | Covered |
| G73.7 | ICD10CM | Covered |
| G80.0 | ICD10CM | Covered |
| G80.1 | ICD10CM | Covered |
| G80.2 | ICD10CM | Covered |
| G80.4 | ICD10CM | Covered |
| G80.8 | ICD10CM | Covered |
| G80.9 | ICD10CM | Covered |
| H04.121 | ICD10CM | Covered |
| H04.122 | ICD10CM | Covered |
| H04.123 | ICD10CM | Covered |
| H16.011 | ICD10CM | Covered |
| H16.012 | ICD10CM | Covered |
| H16.013 | ICD10CM | Covered |
| H16.021 | ICD10CM | Covered |
| H16.022 | ICD10CM | Covered |
| H16.023 | ICD10CM | Covered |
| H16.031 | ICD10CM | Covered |
| H16.032 | ICD10CM | Covered |
| H16.033 | ICD10CM | Covered |
| H16.041 | ICD10CM | Covered |
| H16.042 | ICD10CM | Covered |
| H16.043 | ICD10CM | Covered |
| H16.051 | ICD10CM | Covered |
| H16.052 | ICD10CM | Covered |
| H16.053 | ICD10CM | Covered |
| H16.061 | ICD10CM | Covered |
| H16.062 | ICD10CM | Covered |
| H16.063 | ICD10CM | Covered |
| H16.071 | ICD10CM | Covered |
| H16.072 | ICD10CM | Covered |
| H16.073 | ICD10CM | Covered |
| H16.111 | ICD10CM | Covered |
| H16.112 | ICD10CM | Covered |
| H16.113 | ICD10CM | Covered |
| H16.121 | ICD10CM | Covered |
| H16.122 | ICD10CM | Covered |
| H16.123 | ICD10CM | Covered |
| H16.141 | ICD10CM | Covered |
| H16.142 | ICD10CM | Covered |
| H16.143 | ICD10CM | Covered |
| H16.211 | ICD10CM | Covered |
| H16.212 | ICD10CM | Covered |
| H16.213 | ICD10CM | Covered |
| H16.221 | ICD10CM | Covered |
| H16.222 | ICD10CM | Covered |
| H16.223 | ICD10CM | Covered |
| H16.231 | ICD10CM | Covered |
| H16.232 | ICD10CM | Covered |
| H16.233 | ICD10CM | Covered |
| H18.11 | ICD10CM | Covered |
| H18.12 | ICD10CM | Covered |
| H18.13 | ICD10CM | Covered |
| H18.421 | ICD10CM | Covered |
| H18.422 | ICD10CM | Covered |
| H18.423 | ICD10CM | Covered |
| H18.51 | ICD10CM | Covered |
| H18.601 | ICD10CM | Covered |
| H18.602 | ICD10CM | Covered |
| H18.603 | ICD10CM | Covered |
| H18.611 | ICD10CM | Covered |
| H18.612 | ICD10CM | Covered |
| H18.613 | ICD10CM | Covered |
| H18.621 | ICD10CM | Covered |
| H18.622 | ICD10CM | Covered |
| H18.623 | ICD10CM | Covered |
| H18.731 | ICD10CM | Covered |
| H18.732 | ICD10CM | Covered |
| H18.733 | ICD10CM | Covered |
| H18.831 | ICD10CM | Covered |
| H18.832 | ICD10CM | Covered |
| H18.833 | ICD10CM | Covered |
| H27.01 | ICD10CM | Covered |
| H27.02 | ICD10CM | Covered |
| H27.03 | ICD10CM | Covered |
| H33.001 | ICD10CM | Covered |
| H33.002 | ICD10CM | Covered |
| H33.003 | ICD10CM | Covered |
| H33.011 | ICD10CM | Covered |
| H33.012 | ICD10CM | Covered |
| H33.013 | ICD10CM | Covered |
| H33.021 | ICD10CM | Covered |
| H33.022 | ICD10CM | Covered |
| H33.023 | ICD10CM | Covered |
| H33.031 | ICD10CM | Covered |
| H33.032 | ICD10CM | Covered |
| H33.033 | ICD10CM | Covered |
| H33.041 | ICD10CM | Covered |
| H33.042 | ICD10CM | Covered |
| H33.043 | ICD10CM | Covered |
| H33.051 | ICD10CM | Covered |
| H33.052 | ICD10CM | Covered |
| H33.053 | ICD10CM | Covered |
| H33.191 | ICD10CM | Covered |
| H33.192 | ICD10CM | Covered |
| H33.193 | ICD10CM | Covered |
| H33.301 | ICD10CM | Covered |
| H33.302 | ICD10CM | Covered |
| H33.303 | ICD10CM | Covered |
| H33.311 | ICD10CM | Covered |
| H33.312 | ICD10CM | Covered |
| H33.313 | ICD10CM | Covered |
| H33.321 | ICD10CM | Covered |
| H33.322 | ICD10CM | Covered |
| H33.323 | ICD10CM | Covered |
| H33.331 | ICD10CM | Covered |
| H33.332 | ICD10CM | Covered |
| H33.333 | ICD10CM | Covered |
| H33.41 | ICD10CM | Covered |
| H33.42 | ICD10CM | Covered |
| H33.43 | ICD10CM | Covered |
| H33.8 | ICD10CM | Covered |
| H44.21 | ICD10CM | Covered |
| H44.22 | ICD10CM | Covered |
| H44.23 | ICD10CM | Covered |
| H44.2A1 | ICD10CM | Covered |
| H44.2A2 | ICD10CM | Covered |
| H44.2A3 | ICD10CM | Covered |
| H44.2B1 | ICD10CM | Covered |
| H44.2B2 | ICD10CM | Covered |
| H44.2B3 | ICD10CM | Covered |
| H44.2C1 | ICD10CM | Covered |
| H44.2C2 | ICD10CM | Covered |
| H44.2C3 | ICD10CM | Covered |
| H44.2D1 | ICD10CM | Covered |
| H44.2D2 | ICD10CM | Covered |
| H44.2D3 | ICD10CM | Covered |
| H44.2E1 | ICD10CM | Covered |
| H44.2E2 | ICD10CM | Covered |
| H44.2E3 | ICD10CM | Covered |
| H44.411 | ICD10CM | Covered |
| H44.412 | ICD10CM | Covered |
| H44.413 | ICD10CM | Covered |
| H44.421 | ICD10CM | Covered |
| H44.422 | ICD10CM | Covered |
| H44.423 | 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 |
| H50.111 | 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 |
| H50.30 | 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 |
| H50.411 | ICD10CM | Covered |
| H50.412 | ICD10CM | Covered |
| H50.42 | ICD10CM | Covered |
| H50.51 | ICD10CM | Covered |
| H50.52 | ICD10CM | Covered |
| H50.53 | ICD10CM | Covered |
| H50.54 | ICD10CM | Covered |
| H50.55 | ICD10CM | Covered |
| H52.31 | ICD10CM | Covered |
| H52.32 | ICD10CM | Covered |
| H53.001 | ICD10CM | Covered |
| H53.002 | ICD10CM | Covered |
| H53.003 | ICD10CM | Covered |
| H53.011 | ICD10CM | Covered |
| H53.012 | ICD10CM | Covered |
| H53.013 | ICD10CM | Covered |
| H53.021 | ICD10CM | Covered |
| H53.022 | ICD10CM | Covered |
| H53.023 | ICD10CM | Covered |
| H53.031 | ICD10CM | Covered |
| H53.032 | ICD10CM | Covered |
| H53.033 | ICD10CM | Covered |
| H53.041 | ICD10CM | Covered |
| H53.042 | ICD10CM | Covered |
| H53.043 | ICD10CM | Covered |
| H53.2 | ICD10CM | Covered |
| H54.0X33 | ICD10CM | Covered |
| H54.0X34 | ICD10CM | Covered |
| H54.0X35 | ICD10CM | Covered |
| H54.0X43 | ICD10CM | Covered |
| H54.0X44 | ICD10CM | Covered |
| H54.0X45 | ICD10CM | Covered |
| H54.0X53 | ICD10CM | Covered |
| H54.0X54 | ICD10CM | Covered |
| H54.0X55 | ICD10CM | Covered |
| H54.1131 | ICD10CM | Covered |
| H54.1132 | ICD10CM | Covered |
| H54.1141 | ICD10CM | Covered |
| H54.1142 | ICD10CM | Covered |
| H54.1151 | ICD10CM | Covered |
| H54.1152 | ICD10CM | Covered |
| H54.1213 | ICD10CM | Covered |
| H54.1214 | ICD10CM | Covered |
| H54.1215 | ICD10CM | Covered |
| H54.1223 | ICD10CM | Covered |
| H54.1224 | ICD10CM | Covered |
| H54.1225 | ICD10CM | Covered |
| H54.2X11 | ICD10CM | Covered |
| H54.2X12 | ICD10CM | Covered |
| H54.2X21 | ICD10CM | Covered |
| H54.2X22 | ICD10CM | Covered |
| H54.413A | ICD10CM | Covered |
| H54.414A | ICD10CM | Covered |
| H54.415A | ICD10CM | Covered |
| H54.42A3 | ICD10CM | Covered |
| H54.42A4 | ICD10CM | Covered |
| H54.42A5 | ICD10CM | Covered |
| H54.511A | ICD10CM | Covered |
| H54.512A | ICD10CM | Covered |
| H54.52A1 | ICD10CM | Covered |
| H54.52A2 | ICD10CM | Covered |
| H81.01 | ICD10CM | Covered |
| H81.02 | ICD10CM | Covered |
| H81.03 | ICD10CM | Covered |
| H81.09 | ICD10CM | Covered |
| H81.10 | ICD10CM | Covered |
| H81.11 | ICD10CM | Covered |
| H81.12 | ICD10CM | Covered |
| H81.13 | ICD10CM | Covered |
| H81.20 | ICD10CM | Covered |
| H81.21 | ICD10CM | Covered |
| H81.22 | ICD10CM | Covered |
| H81.23 | ICD10CM | Covered |
| H81.311 | ICD10CM | Covered |
| H81.312 | ICD10CM | Covered |
| H81.313 | ICD10CM | Covered |
| H81.319 | ICD10CM | Covered |
| H81.391 | ICD10CM | Covered |
| H81.392 | ICD10CM | Covered |
| H81.393 | ICD10CM | Covered |
| H81.399 | ICD10CM | Covered |
| H83.01 | ICD10CM | Covered |
| H83.02 | ICD10CM | Covered |
| H83.03 | ICD10CM | Covered |
| H83.09 | ICD10CM | Covered |
| H83.11 | ICD10CM | Covered |
| H83.12 | ICD10CM | Covered |
| H83.13 | ICD10CM | Covered |
| H83.19 | ICD10CM | Covered |
| H83.2X1 | ICD10CM | Covered |
| H83.2X2 | ICD10CM | Covered |
| H83.2X3 | ICD10CM | Covered |
| H83.2X9 | ICD10CM | Covered |
| M35.01 | ICD10CM | Covered |
| M35.02 | ICD10CM | Covered |
| M35.03 | ICD10CM | Covered |
| M35.04 | ICD10CM | Covered |
| M35.09 | ICD10CM | Covered |
| P10.0 | ICD10CM | Covered |
| P10.1 | ICD10CM | Covered |
| P10.4 | ICD10CM | Covered |
| P10.8 | ICD10CM | Covered |
| P52.4 | ICD10CM | Covered |
| P52.6 | ICD10CM | Covered |
| P52.8 | ICD10CM | Covered |
| P52.9 | ICD10CM | Covered |
| Q12.3 | ICD10CM | Covered |
| Q13.0 | ICD10CM | Covered |
| Q13.1 | ICD10CM | Covered |
| Q13.2 | ICD10CM | Covered |
| Q87.40 | ICD10CM | Covered |
| Q87.410 | ICD10CM | Covered |
| Q87.418 | ICD10CM | Covered |
| Q87.42 | ICD10CM | Covered |
| Q87.43 | ICD10CM | Covered |
| Q90.0 | ICD10CM | Covered |
| Q90.1 | ICD10CM | Covered |
| Q90.2 | ICD10CM | Covered |
| Q90.9 | ICD10CM | Covered |
| S05.01XA | ICD10CM | Covered |
| S05.01XD | ICD10CM | Covered |
| S05.01XS | ICD10CM | Covered |
| S05.02XA | ICD10CM | Covered |
| S05.02XD | ICD10CM | Covered |
| S05.02XS | ICD10CM | Covered |
| S05.31XA | ICD10CM | Covered |
| S05.31XD | ICD10CM | Covered |
| S05.31XS | ICD10CM | Covered |
| S05.32XA | ICD10CM | Covered |
| S05.32XD | ICD10CM | Covered |
| S05.32XS | ICD10CM | Covered |
| S06.1XAA | ICD10CM | Covered |
| S06.1XAD | ICD10CM | Covered |
| S06.1XAS | ICD10CM | Covered |
| S06.30AA | ICD10CM | Covered |
| S06.30AD | ICD10CM | Covered |
| S06.30AS | ICD10CM | Covered |
| S06.37AA | ICD10CM | Covered |
| S06.37AD | ICD10CM | Covered |
| S06.37AS | ICD10CM | Covered |
| S06.890A | ICD10CM | Covered |
| S06.890D | ICD10CM | Covered |
| S06.890S | ICD10CM | Covered |
| S06.891A | ICD10CM | Covered |
| S06.891D | ICD10CM | Covered |
| S06.891S | ICD10CM | Covered |
| S06.892A | ICD10CM | Covered |
| S06.892D | ICD10CM | Covered |
| S06.892S | ICD10CM | Covered |
| S06.893A | ICD10CM | Covered |
| S06.893D | ICD10CM | Covered |
| S06.893S | ICD10CM | Covered |
| S06.894A | ICD10CM | Covered |
| S06.894D | ICD10CM | Covered |
| S06.894S | ICD10CM | Covered |
| S06.895A | ICD10CM | Covered |
| S06.895D | ICD10CM | Covered |
| S06.895S | ICD10CM | Covered |
| S06.896A | ICD10CM | Covered |
| S06.896D | ICD10CM | Covered |
| S06.896S | ICD10CM | Covered |
| S06.899A | ICD10CM | Covered |
| S06.899D | ICD10CM | Covered |
| S06.899S | ICD10CM | Covered |
| S06.89AA | ICD10CM | Covered |
| S06.89AD | ICD10CM | Covered |
| S06.89AS | ICD10CM | Covered |
| S06.9X0A | ICD10CM | Covered |
| S06.9X0D | ICD10CM | Covered |
| S06.9X0S | ICD10CM | Covered |
| S06.9X1A | ICD10CM | Covered |
| S06.9X1D | ICD10CM | Covered |
| S06.9X1S | ICD10CM | Covered |
| S06.9X2A | ICD10CM | Covered |
| S06.9X2D | ICD10CM | Covered |
| S06.9X2S | ICD10CM | Covered |
| S06.9X3A | ICD10CM | Covered |
| S06.9X3D | ICD10CM | Covered |
| S06.9X3S | ICD10CM | Covered |
| S06.9X4A | ICD10CM | Covered |
| S06.9X4D | ICD10CM | Covered |
| S06.9X4S | ICD10CM | Covered |
| S06.9X5A | ICD10CM | Covered |
| S06.9X5D | ICD10CM | Covered |
| S06.9X5S | ICD10CM | Covered |
| S06.9X6A | ICD10CM | Covered |
| S06.9X6D | ICD10CM | Covered |
| S06.9X6S | ICD10CM | Covered |
| S06.9X9A | ICD10CM | Covered |
| S06.9X9D | ICD10CM | Covered |
| S06.9X9S | ICD10CM | Covered |
| S06.9XAA | ICD10CM | Covered |
| S06.9XAD | ICD10CM | Covered |
| S06.9XAS | ICD10CM | Covered |
| T15.01XA | ICD10CM | Covered |
| T15.01XD | ICD10CM | Covered |
| T15.01XS | ICD10CM | Covered |
| T15.02XA | ICD10CM | Covered |
| T15.02XD | ICD10CM | Covered |
| T15.02XS | ICD10CM | Covered |
| T26.11XA | ICD10CM | Covered |
| T26.11XD | ICD10CM | Covered |
| T26.11XS | ICD10CM | Covered |
| T26.12XA | ICD10CM | Covered |
| T26.12XD | ICD10CM | Covered |
| T26.12XS | ICD10CM | Covered |
| T26.61XA | ICD10CM | Covered |
| T26.61XD | ICD10CM | Covered |
| T26.61XS | ICD10CM | Covered |
| T26.62XA | ICD10CM | Covered |
| T26.62XD | ICD10CM | Covered |
| T26.62XS | ICD10CM | Covered |
| T85.21XA | ICD10CM | Covered |
| T85.21XD | ICD10CM | Covered |
| T85.21XS | ICD10CM | Covered |
| T85.22XA | ICD10CM | Covered |
| T85.22XD | ICD10CM | Covered |
| T85.22XS | ICD10CM | Covered |
| T85.29XA | ICD10CM | Covered |
| T85.29XD | ICD10CM | Covered |
| T85.29XS | ICD10CM | Covered |
| T85.310A | ICD10CM | Covered |
| T85.310D | ICD10CM | Covered |
| T85.310S | ICD10CM | Covered |
| T85.311A | ICD10CM | Covered |
| T85.311D | ICD10CM | Covered |
| T85.311S | ICD10CM | Covered |
| T85.318A | ICD10CM | Covered |
| T85.318D | ICD10CM | Covered |
| T85.318S | ICD10CM | Covered |
| T85.320A | ICD10CM | Covered |
| T85.320D | ICD10CM | Covered |
| T85.320S | ICD10CM | Covered |
| T85.321A | ICD10CM | Covered |
| T85.321D | ICD10CM | Covered |
| T85.321S | ICD10CM | Covered |
| T85.328A | ICD10CM | Covered |
| T85.328D | ICD10CM | Covered |
| T85.328S | ICD10CM | Covered |
| T85.390A | ICD10CM | Covered |
| T85.390D | ICD10CM | Covered |
| T85.390S | ICD10CM | Covered |
| T85.391A | ICD10CM | Covered |
| T85.391D | ICD10CM | Covered |
| T85.391S | ICD10CM | Covered |
| T85.398A | ICD10CM | Covered |
| T85.398D | ICD10CM | Covered |
| T85.398S | ICD10CM | Covered |
| T85.79XA | ICD10CM | Covered |
| T85.79XD | ICD10CM | Covered |
| T85.79XS | ICD10CM | Covered |
| T85.890A | ICD10CM | Covered |
| T85.890D | ICD10CM | Covered |
| T85.890S | ICD10CM | Covered |
| T85.898A | ICD10CM | Covered |
| T85.898D | ICD10CM | Covered |
| T85.898S | ICD10CM | Covered |
| Z94.7 | ICD10CM | Covered |
| Z96.1 | ICD10CM | Covered |