Diagnosis Codes
Covered Diagnosis Codes for Procedure Codes: 95700, 95705, 95706, 95707,95708, 95709, 95710, 95711, 95712, 95713, 95714, 95715, 95716, 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725, 95726, 95955, and 99184.
F10.11 |
F11.11 |
F11.23 |
F11.93 |
F13.11 |
F13.230 |
F13.231 |
F13.232 |
F13.239 |
F13.930 |
F13.931 |
F13.932 |
F13.939 |
F14.11 |
F14.23 |
F15.11 |
F15.23 |
F15.93 |
F16.11 |
F18.11 |
F19.11 |
F19.230 |
F19.231 |
F19.232 |
F19.239 |
F19.930 |
F19.931 |
F19.932 |
F19.939 |
G40.001 |
G40.009 |
G40.011 |
G40.019 |
G40.101 |
G40.109 |
G40.111 |
G40.119 |
G40.201 |
G40.209 |
G40.211 |
G40.219 |
G40.301 |
G40.309 |
G40.311 |
G40.319 |
G40.401 |
G40.409 |
G40.11 |
G40.419 |
G40.501 |
G40.509 |
G40.801 |
G40.802 |
G40.803 |
G40.04 |
G40.811 |
G40.812 |
G40.813 |
G40.814 |
G40.821 |
G40.822 |
G40.823 |
G40.824 |
G40.89 |
G40.901 |
G40.909 |
G40.911 |
G40.919 |
G40.A01 |
G40.A09 |
G40.A11 |
G40.A19 |
G40.B01 |
G40.B09 |
G40.B11 |
G40.B19 |
G43.101 |
G43.109 |
G43.111 |
G43.119 |
G43.501 |
G43.509 |
G43.511 |
G43.519 |
G43.601 |
G43.609 |
G43.611 |
G43.619 |
P10.0 |
P90 |
R40.1 |
R40.2110 |
R40.2111 |
R40.2112 |
R40.2113 |
R40.2114 |
R40.2120 |
R40.2121 |
R40.2122 |
R40.2123 |
R40.2124 |
R40.2130 |
R40.2131 |
R40.2132 |
R40.2133 |
R40.2134 |
R40.2140 |
R40.2141 |
R40.2142 |
R40.2143 |
R40.2144 |
R40.2210 |
R40.2211 |
R40.2212 |
R40.2213 |
R40.2214 |
R40.2220 |
R40.2221 |
R40.2222 |
R40.2223 |
R40.2224 |
R40.2230 |
R40.2231 |
R40.2232 |
R40.2233 |
R40.2234 |
R40.2240 |
R40.2241 |
R40.2242 |
R40.2243 |
R40.2244 |
R40.2250 |
R40.2251 |
R40.252 |
R40.2253 |
R40.2254 |
R40.2310 |
R40.2311 |
R40.2312 |
R40.2313 |
R40.2314 |
R40.2320 |
R40.2321 |
R40.2322 |
R40.2323 |
R40.2324 |
R40.2330 |
R40.2331 |
R40.2332 |
R40.2333 |
R40.2334 |
R40.2340 |
R40.2341 |
R40.2342 |
R40.2343 |
R40.2344 |
R40.2350 |
R40.2351 |
R40.2352 |
R40.2353 |
R40.2354 |
R40.2360 |
R40.2361 |
R40.2362 |
R40.2363 |
R40.2364 |
R40.2410 |
R40.2411 |
R40.2412 |
R40.2413 |
R40.2414 |
R40.2420 |
R40.2421 |
R40.2422 |
R40.2423 |
R40.2424 |
R40.2430 |
R40.2431 |
R40.2432 |
R40.2433 |
R40.2434 |
R40.2440 |
R40.2441 |
R40.2442 |
R40.2443 |
R40.2444 |
R40.3 |
R56.00 |
R56.01 |
R56.1 |
R56.9 |
R94.01 |
S06.5X0A |
S065X0D |
S06.5X0S |
S06.5X1A |
S06.5X1D |
S06.5X1S |
S06.5X2A |
S06.5X2D |
S06.5X2S |
S06.5X3A |
S06.5X3D |
S06.5X3S |
S06.5X4A |
S06.5X4D |
S06.5X4S |
S06.5X5A |
S06.5X5D |
S06.5X5S |
S06.5X6A |
S06.5X6D |
S06.5X6S |
S06.5X7A |
S06.5X8A |
S06.5X9A |
S06.5X9D |
S06.5X9S |
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Non-covered Diagnosis codes
F90.0 |
F90.1 |
F90.2 |
F90.8 |
F90.9 |
Non-covered diagnosis codes for procedure codes: 95812, 95813, 95816, and 95819
G44.001 |
G44.009 |
G44.011 |
G44.019 |
G44.021 |
G44.029 |
G44.031 |
G44.039 |
G44.041 |
G44.049 |
G44.051 |
G44.059 |
G44.091 |
G44.099 |
G44.1 |
G44.201 |
G44.209 |
G44.211 |
G44.219 |
G44.221 |
G44.229 |
G44.301 |
G44.309 |
G44.311 |
G44.319 |
G44.321 |
G44.329 |
G44.40 |
G44.41 |
G44.51 |
G44.52 |
G44.53 |
G44.59 |
G44.81 |
G44.82 |
G44.83 |
G44.84 |
G44.85 |
G44.86 |
G44.89 |
R51.0 |
R51.9 |