Ambetter · PayerPolicy · AMBETTER-CP-VP-63
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.
Showing the first 1,000 of 1,596 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 92081 | CPT | Covered |
| 92082 | CPT | Covered |
| 92083 | CPT | Covered |
| A18.53 | ICD10CM | Covered |
| A52.15 | ICD10CM | Covered |
| B58.01 | 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 |
| 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 |
| C72.21 | 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 |
| C75.1 | ICD10CM | Covered |
| C75.2 | ICD10CM | Covered |
| C75.3 | ICD10CM | Covered |
| C79.31 | ICD10CM | Covered |
| C79.32 | ICD10CM | Covered |
| C79.49 | ICD10CM | Covered |
| D09.21 | ICD10CM | Covered |
| D09.22 | ICD10CM | Covered |
| D18.02 | ICD10CM | Covered |
| D31.01 | ICD10CM | Covered |
| D31.02 | ICD10CM | Covered |
| D31.11 | ICD10CM | Covered |
| D31.12 | ICD10CM | Covered |
| D31.21 | ICD10CM | Covered |
| D31.22 | ICD10CM | Covered |
| D31.31 | ICD10CM | Covered |
| D31.32 | ICD10CM | Covered |
| D31.41 | ICD10CM | Covered |
| D31.42 | ICD10CM | Covered |
| D31.51 | ICD10CM | Covered |
| D31.52 | ICD10CM | Covered |
| D32.0 | ICD10CM | Covered |
| D33.0 | ICD10CM | Covered |
| D33.1 | ICD10CM | Covered |
| D33.3 | ICD10CM | Covered |
| D35.2 | ICD10CM | Covered |
| D35.3 | ICD10CM | Covered |
| D35.4 | ICD10CM | Covered |
| D43.3 | ICD10CM | Covered |
| D44.3 | ICD10CM | Covered |
| D44.4 | ICD10CM | Covered |
| D44.5 | ICD10CM | Covered |
| D49.7 | ICD10CM | Covered |
| D49.81 | ICD10CM | Covered |
| E05.00 | ICD10CM | Covered |
| E05.01 | ICD10CM | Covered |
| E05.10 | ICD10CM | Covered |
| E05.11 | ICD10CM | Covered |
| E05.20 | ICD10CM | Covered |
| E05.21 | ICD10CM | Covered |
| E05.30 | ICD10CM | Covered |
| E05.31 | ICD10CM | Covered |
| E05.40 | ICD10CM | Covered |
| E05.41 | ICD10CM | Covered |
| E08.3211 | ICD10CM | Covered |
| E08.3212 | ICD10CM | Covered |
| E08.3213 | ICD10CM | Covered |
| E08.3291 | ICD10CM | Covered |
| E08.3292 | ICD10CM | Covered |
| E08.3293 | ICD10CM | Covered |
| E08.3311 | ICD10CM | Covered |
| E08.3312 | ICD10CM | Covered |
| E08.3313 | ICD10CM | Covered |
| E08.3391 | ICD10CM | Covered |
| E08.3392 | ICD10CM | Covered |
| E08.3393 | ICD10CM | Covered |
| E08.3411 | ICD10CM | Covered |
| E08.3412 | ICD10CM | Covered |
| E08.3413 | ICD10CM | Covered |
| E08.3491 | ICD10CM | Covered |
| E08.3492 | ICD10CM | Covered |
| E08.3493 | ICD10CM | Covered |
| E08.3511 | ICD10CM | Covered |
| E08.3512 | ICD10CM | Covered |
| E08.3513 | ICD10CM | Covered |
| E08.3521 | ICD10CM | Covered |
| E08.3522 | ICD10CM | Covered |
| E08.3523 | ICD10CM | Covered |
| E08.3531 | ICD10CM | Covered |
| E08.3532 | ICD10CM | Covered |
| E08.3533 | ICD10CM | Covered |
| E08.3541 | ICD10CM | Covered |
| E08.3542 | ICD10CM | Covered |
| E08.3543 | ICD10CM | Covered |
| E08.3551 | ICD10CM | Covered |
| E08.3552 | ICD10CM | Covered |
| E08.3553 | ICD10CM | Covered |
| E08.3591 | ICD10CM | Covered |
| E08.3592 | ICD10CM | Covered |
| E08.3593 | ICD10CM | Covered |
| E08.37X1 | ICD10CM | Covered |
| E08.37X2 | ICD10CM | Covered |
| E08.37X3 | ICD10CM | Covered |
| E09.3211 | ICD10CM | Covered |
| E09.3212 | ICD10CM | Covered |
| E09.3213 | ICD10CM | Covered |
| E09.3291 | ICD10CM | Covered |
| E09.3292 | ICD10CM | Covered |
| E09.3293 | ICD10CM | Covered |
| E09.3311 | ICD10CM | Covered |
| E09.3312 | ICD10CM | Covered |
| E09.3313 | ICD10CM | Covered |
| E09.3391 | ICD10CM | Covered |
| E09.3392 | ICD10CM | Covered |
| E09.3393 | ICD10CM | Covered |
| E09.3411 | ICD10CM | Covered |
| E09.3412 | ICD10CM | Covered |
| E09.3413 | ICD10CM | Covered |
| E09.3491 | ICD10CM | Covered |
| E09.3492 | ICD10CM | Covered |
| E09.3493 | ICD10CM | Covered |
| E09.3511 | ICD10CM | Covered |
| E09.3512 | ICD10CM | Covered |
| E09.3513 | ICD10CM | Covered |
| E09.3521 | ICD10CM | Covered |
| E09.3522 | ICD10CM | Covered |
| E09.3523 | ICD10CM | Covered |
| E09.3531 | ICD10CM | Covered |
| E09.3532 | ICD10CM | Covered |
| E09.3533 | ICD10CM | Covered |
| E09.3541 | ICD10CM | Covered |
| E09.3542 | ICD10CM | Covered |
| E09.3543 | ICD10CM | Covered |
| E09.3551 | ICD10CM | Covered |
| E09.3552 | ICD10CM | Covered |
| E09.3553 | ICD10CM | Covered |
| E09.3591 | ICD10CM | Covered |
| E09.3592 | ICD10CM | Covered |
| E09.3593 | ICD10CM | Covered |
| E09.37X1 | ICD10CM | Covered |
| E09.37X2 | ICD10CM | Covered |
| E09.37X3 | ICD10CM | Covered |
| E10.3211 | ICD10CM | Covered |
| E10.3212 | ICD10CM | Covered |
| E10.3213 | ICD10CM | Covered |
| E10.3291 | ICD10CM | Covered |
| E10.3292 | ICD10CM | Covered |
| E10.3293 | ICD10CM | Covered |
| E10.3311 | ICD10CM | Covered |
| E10.3312 | ICD10CM | Covered |
| E10.3313 | ICD10CM | Covered |
| E10.3391 | ICD10CM | Covered |
| E10.3392 | ICD10CM | Covered |
| E10.3393 | ICD10CM | Covered |
| E10.3411 | ICD10CM | Covered |
| E10.3412 | ICD10CM | Covered |
| E10.3413 | ICD10CM | Covered |
| E10.3491 | ICD10CM | Covered |
| E10.3492 | ICD10CM | Covered |
| E10.3493 | ICD10CM | Covered |
| E10.3511 | ICD10CM | Covered |
| E10.3512 | ICD10CM | Covered |
| E10.3513 | ICD10CM | Covered |
| E10.3521 | ICD10CM | Covered |
| E10.3522 | ICD10CM | Covered |
| E10.3523 | ICD10CM | Covered |
| E10.3531 | ICD10CM | Covered |
| E10.3532 | ICD10CM | Covered |
| E10.3533 | ICD10CM | Covered |
| E10.3541 | ICD10CM | Covered |
| E10.3542 | ICD10CM | Covered |
| E10.3543 | ICD10CM | Covered |
| E10.3551 | ICD10CM | Covered |
| E10.3552 | ICD10CM | Covered |
| E10.3553 | ICD10CM | Covered |
| E10.3591 | ICD10CM | Covered |
| E10.3592 | ICD10CM | Covered |
| E10.3593 | ICD10CM | Covered |
| E10.37X1 | ICD10CM | Covered |
| E10.37X2 | ICD10CM | Covered |
| E10.37X3 | ICD10CM | Covered |
| E11.3211 | ICD10CM | Covered |
| E11.3212 | ICD10CM | Covered |
| E11.3213 | ICD10CM | Covered |
| E11.3291 | ICD10CM | Covered |
| E11.3292 | ICD10CM | Covered |
| E11.3293 | ICD10CM | Covered |
| E11.3311 | ICD10CM | Covered |
| E11.3312 | ICD10CM | Covered |
| E11.3313 | ICD10CM | Covered |
| E11.3391 | ICD10CM | Covered |
| E11.3392 | ICD10CM | Covered |
| E11.3393 | ICD10CM | Covered |
| E11.3411 | ICD10CM | Covered |
| E11.3412 | ICD10CM | Covered |
| E11.3413 | ICD10CM | Covered |
| E11.3491 | ICD10CM | Covered |
| E11.3492 | ICD10CM | Covered |
| E11.3493 | ICD10CM | Covered |
| E11.3511 | ICD10CM | Covered |
| E11.3512 | ICD10CM | Covered |
| E11.3513 | ICD10CM | Covered |
| E11.3521 | ICD10CM | Covered |
| E11.3522 | ICD10CM | Covered |
| E11.3523 | ICD10CM | Covered |
| E11.3531 | ICD10CM | Covered |
| E11.3532 | ICD10CM | Covered |
| E11.3533 | ICD10CM | Covered |
| E11.3541 | ICD10CM | Covered |
| E11.3542 | ICD10CM | Covered |
| E11.3543 | ICD10CM | Covered |
| E11.3551 | ICD10CM | Covered |
| E11.3552 | ICD10CM | Covered |
| E11.3553 | ICD10CM | Covered |
| E11.3591 | ICD10CM | Covered |
| E11.3592 | ICD10CM | Covered |
| E11.3593 | ICD10CM | Covered |
| E11.37X1 | ICD10CM | Covered |
| E11.37X2 | ICD10CM | Covered |
| E11.37X3 | ICD10CM | Covered |
| E13.3211 | ICD10CM | Covered |
| E13.3212 | ICD10CM | Covered |
| E13.3213 | ICD10CM | Covered |
| E13.3291 | ICD10CM | Covered |
| E13.3292 | ICD10CM | Covered |
| E13.3293 | ICD10CM | Covered |
| E13.3311 | ICD10CM | Covered |
| E13.3312 | ICD10CM | Covered |
| E13.3313 | ICD10CM | Covered |
| E13.3391 | ICD10CM | Covered |
| E13.3392 | ICD10CM | Covered |
| E13.3393 | ICD10CM | Covered |
| E13.3411 | ICD10CM | Covered |
| E13.3412 | ICD10CM | Covered |
| E13.3413 | ICD10CM | Covered |
| E13.3491 | ICD10CM | Covered |
| E13.3492 | ICD10CM | Covered |
| E13.3493 | ICD10CM | Covered |
| E13.3511 | ICD10CM | Covered |
| E13.3512 | ICD10CM | Covered |
| E13.3513 | ICD10CM | Covered |
| E13.3521 | ICD10CM | Covered |
| E13.3522 | ICD10CM | Covered |
| E13.3523 | ICD10CM | Covered |
| E13.3531 | ICD10CM | Covered |
| E13.3532 | ICD10CM | Covered |
| E13.3533 | ICD10CM | Covered |
| E13.3541 | ICD10CM | Covered |
| E13.3542 | ICD10CM | Covered |
| E13.3543 | ICD10CM | Covered |
| E13.3551 | ICD10CM | Covered |
| E13.3552 | ICD10CM | Covered |
| E13.3553 | ICD10CM | Covered |
| E13.3591 | ICD10CM | Covered |
| E13.3592 | ICD10CM | Covered |
| E13.3593 | ICD10CM | Covered |
| E13.37X1 | ICD10CM | Covered |
| E13.37X2 | ICD10CM | Covered |
| E13.37X3 | ICD10CM | Covered |
| E22.0 | ICD10CM | Covered |
| E22.1 | ICD10CM | Covered |
| E22.2 | ICD10CM | Covered |
| E23.0 | ICD10CM | Covered |
| E23.1 | ICD10CM | Covered |
| E23.2 | ICD10CM | Covered |
| E23.3 | ICD10CM | Covered |
| E23.6 | ICD10CM | Covered |
| E23.7 | ICD10CM | Covered |
| E24.1 | ICD10CM | Covered |
| E50.0 | ICD10CM | Covered |
| E50.1 | ICD10CM | Covered |
| E50.2 | ICD10CM | Covered |
| E50.3 | ICD10CM | Covered |
| E50.4 | ICD10CM | Covered |
| E50.5 | ICD10CM | Covered |
| E50.6 | ICD10CM | Covered |
| E50.7 | ICD10CM | Covered |
| E64.1 | ICD10CM | Covered |
| E89.3 | ICD10CM | Covered |
| F07.81 | ICD10CM | Covered |
| F44.4 | ICD10CM | Covered |
| F44.5 | ICD10CM | Covered |
| F44.6 | ICD10CM | Covered |
| F44.7 | ICD10CM | Covered |
| G00.0 | ICD10CM | Covered |
| G00.1 | ICD10CM | Covered |
| G00.2 | ICD10CM | Covered |
| G00.3 | ICD10CM | Covered |
| G03.0 | ICD10CM | Covered |
| G03.1 | ICD10CM | Covered |
| G04.01 | ICD10CM | Covered |
| G04.02 | ICD10CM | Covered |
| G04.2 | ICD10CM | Covered |
| G04.31 | ICD10CM | Covered |
| G04.32 | ICD10CM | Covered |
| G06.0 | ICD10CM | Covered |
| G24.5 | ICD10CM | Covered |
| G35 | ICD10CM | Covered |
| G36.0 | ICD10CM | Covered |
| G36.1 | 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 |
| 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 |
| G40.803 | ICD10CM | Covered |
| G40.804 | ICD10CM | Covered |
| G40.811 | ICD10CM | Covered |
| G40.812 | ICD10CM | Covered |
| G40.813 | ICD10CM | Covered |
| G40.814 | ICD10CM | Covered |
| G40.821 | ICD10CM | Covered |
| G40.822 | ICD10CM | Covered |
| G40.823 | ICD10CM | Covered |
| G40.824 | 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 |
| G43.001 | ICD10CM | Covered |
| G43.009 | ICD10CM | Covered |
| G43.011 | ICD10CM | Covered |
| G43.019 | ICD10CM | Covered |
| G43.101 | ICD10CM | Covered |
| G43.109 | ICD10CM | Covered |
| G43.111 | ICD10CM | Covered |
| G43.119 | ICD10CM | Covered |
| G43.401 | ICD10CM | Covered |
| G43.409 | ICD10CM | Covered |
| G43.411 | ICD10CM | Covered |
| G43.419 | ICD10CM | Covered |
| G43.501 | ICD10CM | Covered |
| G43.509 | ICD10CM | Covered |
| G43.511 | ICD10CM | Covered |
| G43.519 | ICD10CM | Covered |
| G43.601 | ICD10CM | Covered |
| G43.609 | ICD10CM | Covered |
| G43.611 | ICD10CM | Covered |
| G43.619 | ICD10CM | Covered |
| G43.701 | ICD10CM | Covered |
| G43.709 | ICD10CM | Covered |
| G43.711 | ICD10CM | Covered |
| G43.719 | ICD10CM | Covered |
| G43.801 | ICD10CM | Covered |
| G43.809 | ICD10CM | Covered |
| G43.811 | ICD10CM | Covered |
| G43.819 | ICD10CM | Covered |
| G43.821 | ICD10CM | Covered |
| G43.829 | ICD10CM | Covered |
| G43.831 | ICD10CM | Covered |
| G43.839 | ICD10CM | Covered |
| G43.B0 | ICD10CM | Covered |
| G43.B1 | ICD10CM | Covered |
| G43.C0 | ICD10CM | Covered |
| G43.C1 | ICD10CM | Covered |
| G43.E09 | ICD10CM | Covered |
| G43.E11 | ICD10CM | Covered |
| G43.E19 | ICD10CM | Covered |
| G44.001 | ICD10CM | Covered |
| G44.009 | ICD10CM | Covered |
| G44.011 | ICD10CM | Covered |
| G44.019 | ICD10CM | Covered |
| G44.021 | ICD10CM | Covered |
| G44.029 | ICD10CM | Covered |
| G44.031 | ICD10CM | Covered |
| G44.039 | ICD10CM | Covered |
| G44.041 | ICD10CM | Covered |
| G44.049 | ICD10CM | Covered |
| G44.051 | ICD10CM | Covered |
| G44.059 | ICD10CM | Covered |
| G44.091 | ICD10CM | Covered |
| G44.099 | ICD10CM | Covered |
| G44.211 | ICD10CM | Covered |
| G44.219 | ICD10CM | Covered |
| G44.221 | ICD10CM | Covered |
| G44.229 | ICD10CM | Covered |
| G44.301 | ICD10CM | Covered |
| G44.309 | ICD10CM | Covered |
| G44.311 | ICD10CM | Covered |
| G44.319 | ICD10CM | Covered |
| G44.321 | ICD10CM | Covered |
| G44.329 | ICD10CM | Covered |
| G44.40 | ICD10CM | Covered |
| G44.41 | ICD10CM | Covered |
| G44.51 | ICD10CM | Covered |
| G44.52 | ICD10CM | Covered |
| G45.0 | ICD10CM | Covered |
| G45.1 | ICD10CM | Covered |
| G45.2 | ICD10CM | Covered |
| G45.3 | ICD10CM | Covered |
| G45.4 | ICD10CM | Covered |
| G46.0 | ICD10CM | Covered |
| G46.1 | ICD10CM | Covered |
| G46.2 | ICD10CM | Covered |
| G46.3 | ICD10CM | Covered |
| G46.4 | ICD10CM | Covered |
| G46.5 | ICD10CM | Covered |
| G46.6 | ICD10CM | Covered |
| G80.2 | 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 |
| G91.2 | ICD10CM | Covered |
| G92 | ICD10CM | Covered |
| G93.2 | ICD10CM | Covered |
| G93.41 | ICD10CM | Covered |
| G93.5 | ICD10CM | Covered |
| H02.211 | ICD10CM | Covered |
| H02.212 | ICD10CM | Covered |
| H02.214 | ICD10CM | Covered |
| H02.215 | ICD10CM | Covered |
| H02.21A | ICD10CM | Covered |
| H02.21B | ICD10CM | Covered |
| H02.21C | ICD10CM | Covered |
| H02.221 | ICD10CM | Covered |
| H02.222 | ICD10CM | Covered |
| H02.224 | ICD10CM | Covered |
| H02.225 | ICD10CM | Covered |
| H02.22A | ICD10CM | Covered |
| H02.22B | ICD10CM | Covered |
| H02.22C | ICD10CM | Covered |
| H02.231 | ICD10CM | Covered |
| H02.232 | ICD10CM | Covered |
| H02.234 | ICD10CM | Covered |
| H02.235 | ICD10CM | Covered |
| H02.23A | ICD10CM | Covered |
| H02.23B | ICD10CM | Covered |
| H02.23C | ICD10CM | Covered |
| H02.31 | ICD10CM | Covered |
| H02.32 | ICD10CM | Covered |
| H02.34 | ICD10CM | Covered |
| H02.35 | ICD10CM | Covered |
| H02.411 | ICD10CM | Covered |
| H02.412 | ICD10CM | Covered |
| H02.413 | 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 |
| H02.831 | ICD10CM | Covered |
| H02.832 | ICD10CM | Covered |
| H02.834 | ICD10CM | Covered |
| H02.835 | ICD10CM | Covered |
| H02.841 | ICD10CM | Covered |
| H02.842 | ICD10CM | Covered |
| H02.844 | ICD10CM | Covered |
| H02.845 | ICD10CM | Covered |
| H02.851 | ICD10CM | Covered |
| H02.852 | ICD10CM | Covered |
| H02.854 | ICD10CM | Covered |
| H02.855 | ICD10CM | Covered |
| H05.011 | ICD10CM | Covered |
| H05.012 | ICD10CM | Covered |
| H05.013 | ICD10CM | Covered |
| H05.021 | ICD10CM | Covered |
| H05.022 | ICD10CM | Covered |
| H05.023 | ICD10CM | Covered |
| H05.031 | ICD10CM | Covered |
| H05.032 | ICD10CM | Covered |
| H05.033 | ICD10CM | Covered |
| H05.041 | ICD10CM | Covered |
| H05.042 | ICD10CM | Covered |
| H05.043 | ICD10CM | Covered |
| H05.111 | ICD10CM | Covered |
| H05.112 | ICD10CM | Covered |
| H05.113 | ICD10CM | Covered |
| H05.121 | ICD10CM | Covered |
| H05.122 | ICD10CM | Covered |
| H05.123 | ICD10CM | Covered |
| H05.211 | ICD10CM | Covered |
| H05.212 | ICD10CM | Covered |
| H05.213 | ICD10CM | Covered |
| H05.221 | ICD10CM | Covered |
| H05.222 | ICD10CM | Covered |
| H05.223 | ICD10CM | Covered |
| H05.231 | ICD10CM | Covered |
| H05.232 | ICD10CM | Covered |
| H05.233 | ICD10CM | Covered |
| H05.241 | ICD10CM | Covered |
| H05.242 | ICD10CM | Covered |
| H05.243 | ICD10CM | Covered |
| H05.251 | ICD10CM | Covered |
| H05.252 | ICD10CM | Covered |
| H05.253 | ICD10CM | Covered |
| H05.261 | ICD10CM | Covered |
| H05.262 | ICD10CM | Covered |
| H05.263 | ICD10CM | Covered |
| H05.311 | ICD10CM | Covered |
| H05.312 | ICD10CM | Covered |
| H05.313 | ICD10CM | Covered |
| H05.321 | ICD10CM | Covered |
| H05.322 | ICD10CM | Covered |
| H05.323 | ICD10CM | Covered |
| H05.331 | ICD10CM | Covered |
| H05.332 | ICD10CM | Covered |
| H05.333 | ICD10CM | Covered |
| H05.341 | ICD10CM | Covered |
| H05.342 | ICD10CM | Covered |
| H05.343 | ICD10CM | Covered |
| H05.351 | ICD10CM | Covered |
| H05.352 | ICD10CM | Covered |
| H05.353 | ICD10CM | Covered |
| H05.411 | ICD10CM | Covered |
| H05.412 | ICD10CM | Covered |
| H05.413 | ICD10CM | Covered |
| H05.421 | ICD10CM | Covered |
| H05.422 | ICD10CM | Covered |
| H05.423 | ICD10CM | Covered |
| H05.51 | ICD10CM | Covered |
| H05.52 | ICD10CM | Covered |
| H05.53 | ICD10CM | Covered |
| H05.811 | ICD10CM | Covered |
| H05.812 | ICD10CM | Covered |
| H05.813 | ICD10CM | Covered |
| H05.821 | ICD10CM | Covered |
| H05.822 | ICD10CM | Covered |
| H05.823 | ICD10CM | Covered |
| H17.01 | ICD10CM | Covered |
| H17.02 | ICD10CM | Covered |
| H17.03 | ICD10CM | Covered |
| H17.11 | ICD10CM | Covered |
| H17.12 | ICD10CM | Covered |
| H17.13 | ICD10CM | Covered |
| H17.811 | ICD10CM | Covered |
| H17.812 | ICD10CM | Covered |
| H17.813 | ICD10CM | Covered |
| H17.821 | ICD10CM | Covered |
| H17.822 | ICD10CM | Covered |
| H17.823 | ICD10CM | Covered |
| H20.011 | ICD10CM | Covered |
| H20.012 | ICD10CM | Covered |
| H20.013 | ICD10CM | Covered |
| H20.021 | ICD10CM | Covered |
| H20.022 | ICD10CM | Covered |
| H20.023 | ICD10CM | Covered |
| H20.031 | ICD10CM | Covered |
| H20.032 | ICD10CM | Covered |
| H20.033 | ICD10CM | Covered |
| H20.041 | ICD10CM | Covered |
| H20.042 | ICD10CM | Covered |
| H20.043 | ICD10CM | Covered |
| H20.051 | ICD10CM | Covered |
| H20.052 | ICD10CM | Covered |
| H20.053 | ICD10CM | Covered |
| H20.11 | ICD10CM | Covered |
| H20.12 | ICD10CM | Covered |
| H20.13 | ICD10CM | Covered |
| H20.21 | ICD10CM | Covered |
| H20.22 | ICD10CM | Covered |
| H20.23 | ICD10CM | Covered |
| H20.811 | ICD10CM | Covered |
| H20.812 | ICD10CM | Covered |
| H20.813 | ICD10CM | Covered |
| H20.821 | ICD10CM | Covered |
| H20.822 | ICD10CM | Covered |
| H20.823 | ICD10CM | Covered |
| H21.01 | ICD10CM | Covered |
| H21.02 | ICD10CM | Covered |
| H21.03 | ICD10CM | Covered |
| H21.211 | ICD10CM | Covered |
| H21.212 | ICD10CM | Covered |
| H21.213 | ICD10CM | Covered |
| H21.221 | ICD10CM | Covered |
| H21.222 | ICD10CM | Covered |
| H21.223 | ICD10CM | Covered |
| H21.231 | ICD10CM | Covered |
| H21.232 | ICD10CM | Covered |
| H21.233 | ICD10CM | Covered |
| H21.241 | ICD10CM | Covered |
| H21.242 | ICD10CM | Covered |
| H21.243 | ICD10CM | Covered |
| H21.251 | ICD10CM | Covered |
| H21.252 | ICD10CM | Covered |
| H21.253 | ICD10CM | Covered |
| H21.261 | ICD10CM | Covered |
| H21.262 | ICD10CM | Covered |
| H21.263 | ICD10CM | Covered |
| H21.271 | ICD10CM | Covered |
| H21.272 | ICD10CM | Covered |
| H21.273 | ICD10CM | Covered |
| H21.301 | ICD10CM | Covered |
| H21.302 | ICD10CM | Covered |
| H21.303 | ICD10CM | Covered |
| H21.311 | ICD10CM | Covered |
| H21.312 | ICD10CM | Covered |
| H21.313 | ICD10CM | Covered |
| H21.321 | ICD10CM | Covered |
| H21.322 | ICD10CM | Covered |
| H21.323 | ICD10CM | Covered |
| H21.331 | ICD10CM | Covered |
| H21.332 | ICD10CM | Covered |
| H21.333 | ICD10CM | Covered |
| H21.341 | ICD10CM | Covered |
| H21.342 | ICD10CM | Covered |
| H21.343 | ICD10CM | Covered |
| H21.351 | ICD10CM | Covered |
| H21.352 | ICD10CM | Covered |
| H21.353 | ICD10CM | Covered |
| H21.41 | ICD10CM | Covered |
| H21.42 | ICD10CM | Covered |
| H21.43 | ICD10CM | Covered |
| H21.511 | ICD10CM | Covered |
| H21.512 | ICD10CM | Covered |
| H21.513 | ICD10CM | Covered |
| H21.521 | ICD10CM | Covered |
| H21.522 | ICD10CM | Covered |
| H21.523 | ICD10CM | Covered |
| H21.531 | ICD10CM | Covered |
| H21.532 | ICD10CM | Covered |
| H21.533 | ICD10CM | Covered |
| H21.541 | ICD10CM | Covered |
| H21.542 | ICD10CM | Covered |
| H21.543 | ICD10CM | Covered |
| H21.551 | ICD10CM | Covered |
| H21.552 | ICD10CM | Covered |
| H21.553 | ICD10CM | Covered |
| H21.561 | ICD10CM | Covered |
| H21.562 | ICD10CM | Covered |
| H21.563 | ICD10CM | Covered |
| H21.81 | ICD10CM | Covered |
| H21.82 | ICD10CM | Covered |
| H30.011 | ICD10CM | Covered |
| H30.012 | ICD10CM | Covered |
| H30.013 | ICD10CM | Covered |
| H30.021 | ICD10CM | Covered |
| H30.022 | ICD10CM | Covered |
| H30.023 | ICD10CM | Covered |
| H30.031 | ICD10CM | Covered |
| H30.032 | ICD10CM | Covered |
| H30.033 | ICD10CM | Covered |
| H30.041 | ICD10CM | Covered |
| H30.042 | ICD10CM | Covered |
| H30.043 | ICD10CM | Covered |
| H30.111 | ICD10CM | Covered |
| H30.112 | ICD10CM | Covered |
| H30.113 | ICD10CM | Covered |
| H30.121 | ICD10CM | Covered |
| H30.122 | ICD10CM | Covered |
| H30.123 | ICD10CM | Covered |
| H30.131 | ICD10CM | Covered |
| H30.132 | ICD10CM | Covered |
| H30.133 | ICD10CM | Covered |
| H30.141 | ICD10CM | Covered |
| H30.142 | ICD10CM | Covered |
| H30.143 | ICD10CM | Covered |
| H30.21 | ICD10CM | Covered |
| H30.22 | ICD10CM | Covered |
| H30.23 | ICD10CM | Covered |
| H30.811 | ICD10CM | Covered |
| H30.812 | ICD10CM | Covered |
| H30.813 | ICD10CM | Covered |
| H31.011 | ICD10CM | Covered |
| H31.012 | ICD10CM | Covered |
| H31.013 | ICD10CM | Covered |
| H31.021 | ICD10CM | Covered |
| H31.022 | ICD10CM | Covered |
| H31.023 | ICD10CM | Covered |
| H31.111 | ICD10CM | Covered |
| H31.112 | ICD10CM | Covered |
| H31.113 | ICD10CM | Covered |
| H31.121 | ICD10CM | Covered |
| H31.122 | ICD10CM | Covered |
| H31.123 | ICD10CM | Covered |
| H31.21 | ICD10CM | Covered |
| H31.22 | ICD10CM | Covered |
| H31.23 | ICD10CM | Covered |
| H31.311 | ICD10CM | Covered |
| H31.312 | ICD10CM | Covered |
| H31.313 | ICD10CM | Covered |
| H31.321 | ICD10CM | Covered |
| H31.322 | ICD10CM | Covered |
| H31.323 | ICD10CM | Covered |
| H31.411 | ICD10CM | Covered |
| H31.412 | ICD10CM | Covered |
| H31.413 | ICD10CM | Covered |
| H31.421 | ICD10CM | Covered |
| H31.422 | ICD10CM | Covered |
| H31.423 | 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 |
| H33.111 | ICD10CM | Covered |
| H33.112 | ICD10CM | Covered |
| H33.113 | ICD10CM | Covered |
| H33.121 | ICD10CM | Covered |
| H33.122 | ICD10CM | Covered |
| H33.123 | ICD10CM | Covered |
| H33.20 | ICD10CM | Covered |
| H33.21 | ICD10CM | Covered |
| H33.22 | ICD10CM | Covered |
| H33.23 | 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 |
| H34.01 | ICD10CM | Covered |
| H34.02 | ICD10CM | Covered |
| H34.03 | ICD10CM | Covered |
| H34.11 | ICD10CM | Covered |
| H34.12 | ICD10CM | Covered |
| H34.13 | ICD10CM | Covered |
| H34.211 | ICD10CM | Covered |
| H34.212 | ICD10CM | Covered |
| H34.213 | ICD10CM | Covered |
| H34.231 | ICD10CM | Covered |
| H34.232 | ICD10CM | Covered |
| H34.233 | ICD10CM | Covered |
| H34.8110 | ICD10CM | Covered |
| H34.8111 | ICD10CM | Covered |
| H34.8112 | ICD10CM | Covered |
| H34.8120 | ICD10CM | Covered |
| H34.8121 | ICD10CM | Covered |
| H34.8122 | ICD10CM | Covered |
| H34.8130 | ICD10CM | Covered |
| H34.8131 | ICD10CM | Covered |
| H34.8132 | ICD10CM | Covered |
| H34.821 | ICD10CM | Covered |
| H34.822 | ICD10CM | Covered |
| H34.823 | ICD10CM | Covered |
| H34.8310 | ICD10CM | Covered |
| H34.8311 | ICD10CM | Covered |
| H34.8312 | ICD10CM | Covered |
| H34.8320 | ICD10CM | Covered |
| H34.8321 | ICD10CM | Covered |
| H34.8322 | ICD10CM | Covered |
| H34.8330 | ICD10CM | Covered |
| H34.8331 | ICD10CM | Covered |
| H34.8332 | ICD10CM | Covered |
| H35.011 | ICD10CM | Covered |
| H35.012 | ICD10CM | Covered |
| H35.013 | ICD10CM | Covered |
| H35.021 | ICD10CM | Covered |
| H35.022 | ICD10CM | Covered |
| H35.023 | ICD10CM | Covered |
| H35.031 | ICD10CM | Covered |
| H35.032 | ICD10CM | Covered |
| H35.033 | ICD10CM | Covered |
| H35.061 | ICD10CM | Covered |
| H35.062 | ICD10CM | Covered |
| H35.063 | ICD10CM | Covered |
| H35.071 | ICD10CM | Covered |
| H35.072 | ICD10CM | Covered |
| H35.073 | ICD10CM | Covered |
| H35.111 | ICD10CM | Covered |
| H35.112 | ICD10CM | Covered |
| H35.113 | ICD10CM | Covered |
| H35.121 | ICD10CM | Covered |
| H35.122 | ICD10CM | Covered |
| H35.123 | ICD10CM | Covered |
| H35.131 | ICD10CM | Covered |
| H35.132 | ICD10CM | Covered |
| H35.133 | ICD10CM | Covered |
| H35.141 | ICD10CM | Covered |
| H35.142 | ICD10CM | Covered |
| H35.143 | ICD10CM | Covered |
| H35.151 | ICD10CM | Covered |
| H35.152 | ICD10CM | Covered |
| H35.153 | ICD10CM | Covered |
| H35.161 | ICD10CM | Covered |
| H35.162 | ICD10CM | Covered |
| H35.163 | ICD10CM | Covered |
| H35.171 | ICD10CM | Covered |
| H35.172 | ICD10CM | Covered |
| H35.173 | ICD10CM | Covered |
| H35.3111 | ICD10CM | Covered |
| H35.3112 | ICD10CM | Covered |
| H35.3113 | ICD10CM | Covered |
| H35.3114 | ICD10CM | Covered |
| H35.3121 | ICD10CM | Covered |
| H35.3122 | ICD10CM | Covered |
| H35.3123 | ICD10CM | Covered |
| H35.3124 | ICD10CM | Covered |
| H35.3131 | ICD10CM | Covered |
| H35.3132 | ICD10CM | Covered |
| H35.3133 | ICD10CM | Covered |
| H35.3134 | ICD10CM | Covered |
| H35.3211 | ICD10CM | Covered |
| H35.3212 | ICD10CM | Covered |
| H35.3213 | ICD10CM | Covered |
| H35.3221 | ICD10CM | Covered |
| H35.3222 | ICD10CM | Covered |
| H35.3223 | ICD10CM | Covered |
| H35.3231 | ICD10CM | Covered |
| H35.3232 | ICD10CM | Covered |
| H35.3233 | ICD10CM | Covered |
| H35.33 | ICD10CM | Covered |
| H35.341 | ICD10CM | Covered |
| H35.342 | ICD10CM | Covered |
| H35.343 | ICD10CM | Covered |
| H35.351 | ICD10CM | Covered |
| H35.352 | ICD10CM | Covered |
| H35.353 | ICD10CM | Covered |
| H35.361 | ICD10CM | Covered |
| H35.362 | ICD10CM | Covered |
| H35.363 | ICD10CM | Covered |
| H35.371 | ICD10CM | Covered |
| H35.372 | ICD10CM | Covered |
| H35.373 | ICD10CM | Covered |
| H35.381 | ICD10CM | Covered |
| H35.382 | ICD10CM | Covered |
| H35.383 | ICD10CM | Covered |
| H35.411 | ICD10CM | Covered |
| H35.412 | ICD10CM | Covered |
| H35.413 | ICD10CM | Covered |
| H35.421 | ICD10CM | Covered |
| H35.422 | ICD10CM | Covered |
| H35.423 | ICD10CM | Covered |
| H35.431 | ICD10CM | Covered |
| H35.432 | ICD10CM | Covered |
| H35.433 | ICD10CM | Covered |
| H35.441 | ICD10CM | Covered |
| H35.442 | ICD10CM | Covered |
| H35.443 | ICD10CM | Covered |
| H35.451 | ICD10CM | Covered |
| H35.452 | ICD10CM | Covered |
| H35.453 | ICD10CM | Covered |
| H35.461 | ICD10CM | Covered |
| H35.462 | ICD10CM | Covered |
| H35.463 | ICD10CM | Covered |
| H35.51 | ICD10CM | Covered |
| H35.52 | ICD10CM | Covered |
| H35.53 | ICD10CM | Covered |
| H35.54 | ICD10CM | Covered |
| H35.61 | ICD10CM | Covered |
| H35.62 | ICD10CM | Covered |
| H35.63 | ICD10CM | Covered |
| H35.711 | ICD10CM | Covered |
| H35.712 | ICD10CM | Covered |
| H35.713 | ICD10CM | Covered |
| H35.721 | ICD10CM | Covered |
| H35.722 | ICD10CM | Covered |
| H35.723 | ICD10CM | Covered |
| H35.731 | ICD10CM | Covered |
| H35.732 | ICD10CM | Covered |
| H35.733 | ICD10CM | Covered |
| H35.81 | ICD10CM | Covered |
| H35.82 | ICD10CM | Covered |
| H36.811 | ICD10CM | Covered |
| H36.812 | ICD10CM | Covered |
| H36.813 | ICD10CM | Covered |
| H36.821 | ICD10CM | Covered |
| H36.822 | ICD10CM | Covered |
| H36.823 | ICD10CM | Covered |
| H40.011 | ICD10CM | Covered |
| H40.012 | ICD10CM | Covered |
| H40.013 | ICD10CM | Covered |
| H40.021 | ICD10CM | Covered |
| H40.022 | ICD10CM | Covered |
| H40.023 | ICD10CM | Covered |
| H40.031 | ICD10CM | Covered |
| H40.032 | ICD10CM | Covered |
| H40.033 | ICD10CM | Covered |
| H40.041 | ICD10CM | Covered |
| H40.042 | ICD10CM | Covered |
| H40.043 | ICD10CM | Covered |
| H40.051 | ICD10CM | Covered |
| H40.052 | ICD10CM | Covered |
| H40.053 | ICD10CM | Covered |
| H40.061 | ICD10CM | Covered |
| H40.062 | ICD10CM | Covered |
| H40.063 | ICD10CM | Covered |
| H40.1111 | ICD10CM | Covered |
| H40.1112 | ICD10CM | Covered |
| H40.1113 | ICD10CM | Covered |
| H40.1121 | ICD10CM | Covered |
| H40.1122 | ICD10CM | Covered |
| H40.1123 | ICD10CM | Covered |
| H40.1131 | ICD10CM | Covered |
| H40.1132 | ICD10CM | Covered |
| H40.1133 | ICD10CM | Covered |
| H40.1211 | ICD10CM | Covered |
| H40.1212 | ICD10CM | Covered |
| H40.1213 | ICD10CM | Covered |
| H40.1221 | ICD10CM | Covered |
| H40.1222 | ICD10CM | Covered |
| H40.1223 | ICD10CM | Covered |
| H40.1231 | ICD10CM | Covered |
| H40.1232 | ICD10CM | Covered |
| H40.1233 | ICD10CM | Covered |
| H40.1311 | ICD10CM | Covered |
| H40.1312 | ICD10CM | Covered |
| H40.1313 | ICD10CM | Covered |
| H40.1321 | ICD10CM | Covered |
| H40.1322 | ICD10CM | Covered |
| H40.1323 | ICD10CM | Covered |
| H40.1331 | ICD10CM | Covered |
| H40.1332 | ICD10CM | Covered |
| H40.1333 | ICD10CM | Covered |
| H40.1411 | ICD10CM | Covered |
| H40.1412 | ICD10CM | Covered |
| H40.1413 | ICD10CM | Covered |
| H40.1421 | ICD10CM | Covered |
| H40.1422 | ICD10CM | Covered |
| H40.1423 | ICD10CM | Covered |
| H40.1431 | ICD10CM | Covered |
| H40.1432 | ICD10CM | Covered |
| H40.1433 | ICD10CM | Covered |
| H40.151 | ICD10CM | Covered |
| H40.152 | ICD10CM | Covered |
| H40.153 | ICD10CM | Covered |
| H40.211 | ICD10CM | Covered |
| H40.212 | ICD10CM | Covered |
| H40.213 | ICD10CM | Covered |
| H40.2211 | ICD10CM | Covered |
| H40.2212 | ICD10CM | Covered |
| H40.2213 | ICD10CM | Covered |
| H40.2221 | ICD10CM | Covered |
| H40.2222 | ICD10CM | Covered |
| H40.2223 | ICD10CM | Covered |
| H40.2231 | ICD10CM | Covered |
| H40.2232 | ICD10CM | Covered |
| H40.2233 | ICD10CM | Covered |
| H40.231 | ICD10CM | Covered |
| H40.232 | ICD10CM | Covered |
| H40.233 | ICD10CM | Covered |
| H40.241 | ICD10CM | Covered |
| H40.242 | ICD10CM | Covered |
| H40.243 | ICD10CM | Covered |
| H40.31X1 | ICD10CM | Covered |
| H40.31X2 | ICD10CM | Covered |
| H40.31X3 | ICD10CM | Covered |
| H40.32X1 | ICD10CM | Covered |
| H40.32X2 | ICD10CM | Covered |