Diagnosis Codes
Covered Diagnosis Codes for Procedure Codes: L3070, L3080, L3090, L3160, L3201, L3202, 3203, L3212, L3213, L3214, L3215, L3216, L3217, L3219, L3221, L3222, L3224, L3225, L3230, L3251, L3252, L3253, L3254, L3255, L3257, L3265, L3300, L3310, L3320, L3330, L3332, L3334, L3360, L3370, L3390, L3400, L3410, L3420, L3430, L3440, L3450, L3455, L3460, L3465, L3470, L3480, L3485, L3500, L3510, L3520, L3530, L3540, L3550, L3560, L3570, L3580, L3590, L3595, L3600, L3610, L3620, L3630, L3640, L3649
G57.60 |
G57.61 |
G57.62 |
G57.63 |
G57.81 |
G57.82 |
G57.83 |
G57.91 |
G57.92 |
G57.93 |
L11.0 |
L85.0 |
L85.1 |
L85.2 |
L86 |
L87.0 |
L87.2 |
M05.051 |
M05.052 |
M05.061 |
M05.062 |
M05.071 |
M05.072 |
M05.09 |
M05.151 |
M05.152 |
M05.161 |
M05.162 |
M05.171 |
M05.172 |
M05.19 |
M05.251 |
M05.252 |
M05.261 |
M05.262 |
M05.271 |
M05.272 |
M05.29 |
M05.351 |
M05.352 |
M05.361 |
M05.362 |
M05.371 |
M05.372 |
M05.39 |
M05.451 |
M05.452 |
M05.461 |
M05.462 |
M05.471 |
M05.472 |
M05.49 |
M05.551 |
M05.552 |
M05.561 |
M05.562 |
M05.571 |
M05.572 |
M05.59 |
M05.651 |
M05.652 |
M05.661 |
M05.662 |
M05.671 |
M05.672 |
M05.69 |
M05.7A |
M05.751 |
M05.752 |
M05.761 |
M05.762 |
M05.771 |
M05.772 |
M05.79 |
M05.8A |
M05.851 |
M05.852 |
M05.861 |
M05.862 |
M05.871 |
M05.872 |
M05.89 |
M06.0A |
M06.051 |
M06.052 |
M06.061 |
M06.062 |
M06.071 |
M06.072 |
M06.08 |
M06.09 |
M06.1 |
M06.251 |
M06.252 |
M06.261 |
M06.262 |
M06.271 |
M06.272 |
M06.28 |
M06.29 |
M06.351 |
M06.352 |
M06.361 |
M06.362 |
M06.371 |
M06.372 |
M06.38 |
M06.39 |
M06.4 |
M06.8A |
M06.851 |
M06.852 |
M06.861 |
M06.862 |
M06.871 |
M06.872 |
M06.88 |
M06.89 |
M08.0A |
M08.051 |
M08.052 |
M08.061 |
M08.062 |
M08.071 |
M08.072 |
M08.08 |
M08.09 |
M08.2A |
M08.251 |
M08.252 |
M08.261 |
M08.262 |
M08.271 |
M08.272 |
M08.28 |
M08.29 |
M08.3 |
M08.4A |
M08.451 |
M08.452 |
M08.461 |
M08.462 |
M08.471 |
M08.472 |
M08.48 |
M08.851 |
M08.852 |
M08.861 |
M08.862 |
M08.871 |
M08.872 |
M08.89 |
M08.9A |
M08.951 |
M08.952 |
M08.961 |
M08.962 |
M08.971 |
M08.972 |
M08.98 |
M08.99 |
M12.051 |
M12.052 |
M12.061 |
M12.062 |
M12.071 |
M12.072 |
M12.09 |
M19.071 |
M19.072 |
M19.09 |
M19.19 |
M19.29 |
M19.171 |
M19.172 |
M19.271 |
M19.272 |
M19.90 |
M20.11 |
M20.12 |
M20.21 |
M20.22 |
M20.30 |
M20.31 |
M20.32 |
M20.41 |
M20.42 |
M20.5X1 |
M20.5X2 |
M20.5X9 |
M20.60 |
M20.61 |
M20.62 |
M21.171 |
M21.172 |
M21.271 |
M21.272 |
M21.279 |
M21.531 |
M21.532 |
M21.539 |
M21.541 |
M21.542 |
M21.549 |
M21.611 |
M21.612 |
M21.621 |
M21.622 |
M21.6X1 |
M21.6X2 |
M21.751 |
M21.752 |
M21.761 |
M21.762 |
M21.763 |
M21.764 |
M22.41 |
M22.42 |
M24.19 |
M24.29 |
M24.39 |
M24.49 |
M24.59 |
M24.69 |
M24.89 |
M25.69 |
M67.961 |
M67.962 |
M72.2 |
M76.61 |
M76.62 |
M76.71 |
M76.72 |
M76.811 |
M76.812 |
M76.821 |
M76.822 |
M77.31 |
M77.32 |
M77.51 |
M77.52 |
M92.61 |
M92.62 |
M92.71 |
M92.72 |
M92.8 |
Q66.00 |
Q66.01 |
Q66.02 |
Q66.10 |
Q66.11 |
Q66.12 |
Q66.211 |
Q66.212 |
Q66.219 |
Q66.221 |
Q66.222 |
Q66.229 |
Q66.30 |
Q66.31 |
Q66.32 |
Q66.40 |
Q66.41 |
Q66.42 |
Q66.70 |
Q66.71 |
Q66.72 |
Q66.81 |
Q66.82 |
Q66.89 |
Q66.90 |
Q66.91 |
Q66.92 |
Q74.2 |
S93.401D |
S93.401S |
S93.402D |
S93.402S |
S93.411D |
S93.411S |
S93.412D |
S93.412S |
S96.901D |
S96.901S |
S96.902D |
S96.902S |
S96.911D |
S96.911S |
S96.912D |
S96.912S |
S96.919A |
Covered Diagnosis Codes For Procedure Codes L3140, L3150, L3204, L3206, L3207, and L3380
M21.171 |
M21.172 |
M21.541 |
M21.542 |
M21.549 |
Q66.00 |
Q66.01 |
Q66.02 |
Q66.89 |