How to read the result
- Listed as covered: the diagnosis is in the article's list of ICD-10-CM codes that support medical necessity for the service. Some lists come with extra rules, such as a second diagnosis that must also be billed. Read the group note.
- Not listed: the article limits the service to the diagnoses it lists, and this one isn't among them. Medicare will likely deny the claim as not medically necessary, so an ABN may be needed before the service.
- Check the article title: an article governs a code only for the service it describes. For example, 20610 appears in the hyaluronan injection article, which applies only when the joint injection is a hyaluronan.
- No article for your state: your contractor has no billing and coding article with a diagnosis list for this code. There may still be a national coverage determination (NCD) or other policy.
Where the data comes from
Local coverage determinations (LCDs) and their billing and coding articles are written by each Medicare Administrative Contractor (MAC). This tool uses the CMS Medicare Coverage Database and checks the articles that apply to the MAC for the state you pick. The data is refreshed every week.
Being listed doesn't guarantee payment: the service must be reasonable and necessary and documented, and articles can have frequency limits and other conditions. This tool covers Medicare Part A/B local coverage only, not Medicare Advantage, Medicaid or commercial plans. Always confirm in the article on cms.gov. CPT is a registered trademark of the American Medical Association; code descriptions aren't shown.