LCD Reference Article Billing and Coding Article

Billing and Coding: Magnetic Resonance Angiography (MRA)

A56805

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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General Information

Source Article ID
N/A
Article ID
A56805
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Magnetic Resonance Angiography (MRA)
Article Type
Billing and Coding
Original Effective Date
08/08/2019
Revision Effective Date
10/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
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CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34865, Magnetic Resonance Angiography (MRA). Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
083x Ambulatory Surgery Center
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
0615 Magnetic Resonance Technology (MRT) - MRA - Head and Neck
0616 Magnetic Resonance Technology (MRT) - MRA - Lower Extremities
0618 Magnetic Resonance Technology (MRT) - MRA - Other
N/A

CPT/HCPCS Codes

Group 1

(6 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

MRA of the Head and Neck

Group 1 Codes
Code Description
70544 Mr angiography head w/o dye
70545 Mr angiography head w/dye
70546 Mr angiograph head w/o&w/dye
70547 Mr angiography neck w/o dye
70548 Mr angiography neck w/dye
70549 Mr angiograph neck w/o&w/dye

Group 2

(4 Codes)
Group 2 Paragraph

MRA of the Peripheral Arteries of Lower Extremities

Group 2 Codes
Code Description
73725 Mr ang lwr ext w or w/o dye
C8912 Mra w/cont, lwr ext
C8913 Mra w/o cont, lwr ext
C8914 Mra w/o fol w/cont, lwr ext

Group 3

(8 Codes)
Group 3 Paragraph

MRA of the Abdomen and Pelvis

Group 3 Codes
Code Description
72198 Mr angio pelvis w/o & w/dye
74185 Mri angio abdom w orw/o dye
C8900 Mra w/cont, abd
C8901 Mra w/o cont, abd
C8902 Mra w/o fol w/cont, abd
C8918 Mra w/cont, pelvis
C8919 Mra w/o cont, pelvis
C8920 Mra w/o fol w/cont, pelvis

Group 4

(4 Codes)
Group 4 Paragraph

MRA of the Chest

Group 4 Codes
Code Description
71555 Mri angio chest w or w/o dye
C8909 Mra w/cont, chest
C8910 Mra w/o cont, chest
C8911 Mra w/o fol w/cont, chest
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(541 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. 

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 70544, 70545, 70546, 70547, 70548, and 70549.

Group 1 Codes
Code Description
A52.05 Other cerebrovascular syphilis
A52.19 Other symptomatic neurosyphilis
C00.0 Malignant neoplasm of external upper lip
C00.1 Malignant neoplasm of external lower lip
C00.2 Malignant neoplasm of external lip, unspecified
C00.3 Malignant neoplasm of upper lip, inner aspect
C00.4 Malignant neoplasm of lower lip, inner aspect
C00.5 Malignant neoplasm of lip, unspecified, inner aspect
C00.6 Malignant neoplasm of commissure of lip, unspecified
C00.8 Malignant neoplasm of overlapping sites of lip
C01 Malignant neoplasm of base of tongue
C02.0 Malignant neoplasm of dorsal surface of tongue
C02.1 Malignant neoplasm of border of tongue
C02.2 Malignant neoplasm of ventral surface of tongue
C02.3 Malignant neoplasm of anterior two-thirds of tongue, part unspecified
C02.4 Malignant neoplasm of lingual tonsil
C02.8 Malignant neoplasm of overlapping sites of tongue
C02.9 Malignant neoplasm of tongue, unspecified
C03.0 Malignant neoplasm of upper gum
C03.1 Malignant neoplasm of lower gum
C03.9 Malignant neoplasm of gum, unspecified
C04.0 Malignant neoplasm of anterior floor of mouth
C04.1 Malignant neoplasm of lateral floor of mouth
C04.8 Malignant neoplasm of overlapping sites of floor of mouth
C04.9 Malignant neoplasm of floor of mouth, unspecified
C05.0 Malignant neoplasm of hard palate
C05.1 Malignant neoplasm of soft palate
C05.2 Malignant neoplasm of uvula
C05.8 Malignant neoplasm of overlapping sites of palate
C06.0 Malignant neoplasm of cheek mucosa
C06.1 Malignant neoplasm of vestibule of mouth
C06.2 Malignant neoplasm of retromolar area
C06.89 Malignant neoplasm of overlapping sites of other parts of mouth
C06.9 Malignant neoplasm of mouth, unspecified
C07 Malignant neoplasm of parotid gland
C08.0 Malignant neoplasm of submandibular gland
C08.1 Malignant neoplasm of sublingual gland
C08.9 Malignant neoplasm of major salivary gland, unspecified
C09.0 Malignant neoplasm of tonsillar fossa
C09.1 Malignant neoplasm of tonsillar pillar (anterior) (posterior)
C09.8 Malignant neoplasm of overlapping sites of tonsil
C10.0 Malignant neoplasm of vallecula
C10.1 Malignant neoplasm of anterior surface of epiglottis
C10.2 Malignant neoplasm of lateral wall of oropharynx
C10.3 Malignant neoplasm of posterior wall of oropharynx
C10.4 Malignant neoplasm of branchial cleft
C10.8 Malignant neoplasm of overlapping sites of oropharynx
C10.9 Malignant neoplasm of oropharynx, unspecified
C11.0 Malignant neoplasm of superior wall of nasopharynx
C11.1 Malignant neoplasm of posterior wall of nasopharynx
C11.2 Malignant neoplasm of lateral wall of nasopharynx
C11.3 Malignant neoplasm of anterior wall of nasopharynx
C11.8 Malignant neoplasm of overlapping sites of nasopharynx
C11.9 Malignant neoplasm of nasopharynx, unspecified
C12 Malignant neoplasm of pyriform sinus
C13.0 Malignant neoplasm of postcricoid region
C13.1 Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect
C13.2 Malignant neoplasm of posterior wall of hypopharynx
C13.8 Malignant neoplasm of overlapping sites of hypopharynx
C13.9 Malignant neoplasm of hypopharynx, unspecified
C33 Malignant neoplasm of trachea
C69.01 Malignant neoplasm of right conjunctiva
C69.02 Malignant neoplasm of left conjunctiva
C69.11 Malignant neoplasm of right cornea
C69.12 Malignant neoplasm of left cornea
C69.21 Malignant neoplasm of right retina
C69.22 Malignant neoplasm of left retina
C69.31 Malignant neoplasm of right choroid
C69.32 Malignant neoplasm of left choroid
C69.41 Malignant neoplasm of right ciliary body
C69.42 Malignant neoplasm of left ciliary body
C69.51 Malignant neoplasm of right lacrimal gland and duct
C69.52 Malignant neoplasm of left lacrimal gland and duct
C69.61 Malignant neoplasm of right orbit
C69.62 Malignant neoplasm of left orbit
C69.81 Malignant neoplasm of overlapping sites of right eye and adnexa
C69.82 Malignant neoplasm of overlapping sites of left eye and adnexa
C70.0 Malignant neoplasm of cerebral meninges
C70.9 Malignant neoplasm of meninges, unspecified
C71.0 Malignant neoplasm of cerebrum, except lobes and ventricles
C71.1 Malignant neoplasm of frontal lobe
C71.2 Malignant neoplasm of temporal lobe
C71.3 Malignant neoplasm of parietal lobe
C71.4 Malignant neoplasm of occipital lobe
C71.5 Malignant neoplasm of cerebral ventricle
C71.6 Malignant neoplasm of cerebellum
C71.7 Malignant neoplasm of brain stem
C71.8 Malignant neoplasm of overlapping sites of brain
C71.9 Malignant neoplasm of brain, unspecified
C75.1 Malignant neoplasm of pituitary gland
C75.2 Malignant neoplasm of craniopharyngeal duct
C75.3 Malignant neoplasm of pineal gland
C75.4 Malignant neoplasm of carotid body
C75.5 Malignant neoplasm of aortic body and other paraganglia
C79.31 Secondary malignant neoplasm of brain
C79.32 Secondary malignant neoplasm of cerebral meninges
C79.49 Secondary malignant neoplasm of other parts of nervous system
D18.02 Hemangioma of intracranial structures
D18.09 Hemangioma of other sites
D32.0 Benign neoplasm of cerebral meninges
D32.9 Benign neoplasm of meninges, unspecified
D33.0 Benign neoplasm of brain, supratentorial
D33.1 Benign neoplasm of brain, infratentorial
D33.3 Benign neoplasm of cranial nerves
D35.2 Benign neoplasm of pituitary gland
D35.3 Benign neoplasm of craniopharyngeal duct
D35.4 Benign neoplasm of pineal gland
D35.5 Benign neoplasm of carotid body
D35.6 Benign neoplasm of aortic body and other paraganglia
D42.0 Neoplasm of uncertain behavior of cerebral meninges
D42.1 Neoplasm of uncertain behavior of spinal meninges
D42.9 Neoplasm of uncertain behavior of meninges, unspecified
D43.0 Neoplasm of uncertain behavior of brain, supratentorial
D43.1 Neoplasm of uncertain behavior of brain, infratentorial
D43.4 Neoplasm of uncertain behavior of spinal cord
D49.6 Neoplasm of unspecified behavior of brain
F01.50 Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F01.A0 Vascular dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F01.A11 Vascular dementia, mild, with agitation
F01.A18 Vascular dementia, mild, with other behavioral disturbance
F01.A2 Vascular dementia, mild, with psychotic disturbance
F01.A3 Vascular dementia, mild, with mood disturbance
F01.A4 Vascular dementia, mild, with anxiety
F01.B0 Vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F01.B11 Vascular dementia, moderate, with agitation
F01.B18 Vascular dementia, moderate, with other behavioral disturbance
F01.B2 Vascular dementia, moderate, with psychotic disturbance
F01.B3 Vascular dementia, moderate, with mood disturbance
F01.B4 Vascular dementia, moderate, with anxiety
F01.C0 Vascular dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F01.C11 Vascular dementia, severe, with agitation
F01.C18 Vascular dementia, severe, with other behavioral disturbance
F01.C2 Vascular dementia, severe, with psychotic disturbance
F01.C3 Vascular dementia, severe, with mood disturbance
F01.C4 Vascular dementia, severe, with anxiety
G08 Intracranial and intraspinal phlebitis and thrombophlebitis
G43.401 Hemiplegic migraine, not intractable, with status migrainosus
G43.409 Hemiplegic migraine, not intractable, without status migrainosus
G43.411 Hemiplegic migraine, intractable, with status migrainosus
G43.419 Hemiplegic migraine, intractable, without status migrainosus
G45.0 Vertebro-basilar artery syndrome
G45.3 Amaurosis fugax
G45.8 Other transient cerebral ischemic attacks and related syndromes
G45.9 Transient cerebral ischemic attack, unspecified
G50.0 Trigeminal neuralgia
G50.8 Other disorders of trigeminal nerve
H34.01 Transient retinal artery occlusion, right eye
H34.02 Transient retinal artery occlusion, left eye
H34.03 Transient retinal artery occlusion, bilateral
H34.11 Central retinal artery occlusion, right eye
H34.12 Central retinal artery occlusion, left eye
H34.13 Central retinal artery occlusion, bilateral
H34.211 Partial retinal artery occlusion, right eye
H34.212 Partial retinal artery occlusion, left eye
H34.213 Partial retinal artery occlusion, bilateral
H34.231 Retinal artery branch occlusion, right eye
H34.232 Retinal artery branch occlusion, left eye
H34.233 Retinal artery branch occlusion, bilateral
H34.9 Unspecified retinal vascular occlusion
H47.021 Hemorrhage in optic nerve sheath, right eye
H47.022 Hemorrhage in optic nerve sheath, left eye
H47.023 Hemorrhage in optic nerve sheath, bilateral
H47.11 Papilledema associated with increased intracranial pressure
H47.141 Foster-Kennedy syndrome, right eye
H47.142 Foster-Kennedy syndrome, left eye
H47.143 Foster-Kennedy syndrome, bilateral
H47.41 Disorders of optic chiasm in (due to) inflammatory disorders
H47.42 Disorders of optic chiasm in (due to) neoplasm
H47.43 Disorders of optic chiasm in (due to) vascular disorders
H47.49 Disorders of optic chiasm in (due to) other disorders
H47.521 Disorders of visual pathways in (due to) neoplasm, right side
H47.522 Disorders of visual pathways in (due to) neoplasm, left side
H47.531 Disorders of visual pathways in (due to) vascular disorders, right side
H47.532 Disorders of visual pathways in (due to) vascular disorders, left side
H47.631 Disorders of visual cortex in (due to) neoplasm, right side of brain
H47.632 Disorders of visual cortex in (due to) neoplasm, left side of brain
H47.641 Disorders of visual cortex in (due to) vascular disorders, right side of brain
H47.642 Disorders of visual cortex in (due to) vascular disorders, left side of brain
H49.01 Third [oculomotor] nerve palsy, right eye
H49.02 Third [oculomotor] nerve palsy, left eye
H49.03 Third [oculomotor] nerve palsy, bilateral
H49.11 Fourth [trochlear] nerve palsy, right eye
H49.12 Fourth [trochlear] nerve palsy, left eye
H49.13 Fourth [trochlear] nerve palsy, bilateral
H49.21 Sixth [abducent] nerve palsy, right eye
H49.22 Sixth [abducent] nerve palsy, left eye
H49.23 Sixth [abducent] nerve palsy, bilateral
H53.121 Transient visual loss, right eye
H53.122 Transient visual loss, left eye
H53.123 Transient visual loss, bilateral
H53.131 Sudden visual loss, right eye
H53.132 Sudden visual loss, left eye
H53.133 Sudden visual loss, bilateral
H53.40 Unspecified visual field defects
H53.461 Homonymous bilateral field defects, right side
H53.462 Homonymous bilateral field defects, left side
H53.47 Heteronymous bilateral field defects
H81.4 Vertigo of central origin
H93.11 Tinnitus, right ear
H93.12 Tinnitus, left ear
H93.13 Tinnitus, bilateral
H93.A1 Pulsatile tinnitus, right ear
H93.A2 Pulsatile tinnitus, left ear
H93.A3 Pulsatile tinnitus, bilateral
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation
I60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation
I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery
I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery
I60.2 Nontraumatic subarachnoid hemorrhage from anterior communicating artery
I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery
I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery
I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery
I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery
I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery
I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries
I60.8 Other nontraumatic subarachnoid hemorrhage
I61.0 Nontraumatic intracerebral hemorrhage in hemisphere, subcortical
I61.1 Nontraumatic intracerebral hemorrhage in hemisphere, cortical
I61.3 Nontraumatic intracerebral hemorrhage in brain stem
I61.4 Nontraumatic intracerebral hemorrhage in cerebellum
I61.5 Nontraumatic intracerebral hemorrhage, intraventricular
I61.6 Nontraumatic intracerebral hemorrhage, multiple localized
I61.8 Other nontraumatic intracerebral hemorrhage
I62.01 Nontraumatic acute subdural hemorrhage
I62.02 Nontraumatic subacute subdural hemorrhage
I62.03 Nontraumatic chronic subdural hemorrhage
I62.1 Nontraumatic extradural hemorrhage
I62.9 Nontraumatic intracranial hemorrhage, unspecified
I63.00 Cerebral infarction due to thrombosis of unspecified precerebral artery
I63.011 Cerebral infarction due to thrombosis of right vertebral artery
I63.012 Cerebral infarction due to thrombosis of left vertebral artery
I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries
I63.02 Cerebral infarction due to thrombosis of basilar artery
I63.031 Cerebral infarction due to thrombosis of right carotid artery
I63.032 Cerebral infarction due to thrombosis of left carotid artery
I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries
I63.09 Cerebral infarction due to thrombosis of other precerebral artery
I63.10 Cerebral infarction due to embolism of unspecified precerebral artery
I63.111 Cerebral infarction due to embolism of right vertebral artery
I63.112 Cerebral infarction due to embolism of left vertebral artery
I63.113 Cerebral infarction due to embolism of bilateral vertebral arteries
I63.12 Cerebral infarction due to embolism of basilar artery
I63.131 Cerebral infarction due to embolism of right carotid artery
I63.132 Cerebral infarction due to embolism of left carotid artery
I63.133 Cerebral infarction due to embolism of bilateral carotid arteries
I63.19 Cerebral infarction due to embolism of other precerebral artery
I63.211 Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery
I63.212 Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery
I63.213 Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries
I63.22 Cerebral infarction due to unspecified occlusion or stenosis of basilar artery
I63.231 Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries
I63.233 Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries
I63.29 Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries
I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery
I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries
I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries
I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries
I63.341 Cerebral infarction due to thrombosis of right cerebellar artery
I63.342 Cerebral infarction due to thrombosis of left cerebellar artery
I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries
I63.39 Cerebral infarction due to thrombosis of other cerebral artery
I63.411 Cerebral infarction due to embolism of right middle cerebral artery
I63.412 Cerebral infarction due to embolism of left middle cerebral artery
I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries
I63.421 Cerebral infarction due to embolism of right anterior cerebral artery
I63.422 Cerebral infarction due to embolism of left anterior cerebral artery
I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries
I63.431 Cerebral infarction due to embolism of right posterior cerebral artery
I63.432 Cerebral infarction due to embolism of left posterior cerebral artery
I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries
I63.441 Cerebral infarction due to embolism of right cerebellar artery
I63.442 Cerebral infarction due to embolism of left cerebellar artery
I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries
I63.49 Cerebral infarction due to embolism of other cerebral artery
I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.513 Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries
I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.523 Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries
I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.533 Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries
I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries
I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction
I65.01 Occlusion and stenosis of right vertebral artery
I65.02 Occlusion and stenosis of left vertebral artery
I65.03 Occlusion and stenosis of bilateral vertebral arteries
I65.1 Occlusion and stenosis of basilar artery
I65.21 Occlusion and stenosis of right carotid artery
I65.22 Occlusion and stenosis of left carotid artery
I65.23 Occlusion and stenosis of bilateral carotid arteries
I65.8 Occlusion and stenosis of other precerebral arteries
I65.9 Occlusion and stenosis of unspecified precerebral artery
I66.01 Occlusion and stenosis of right middle cerebral artery
I66.02 Occlusion and stenosis of left middle cerebral artery
I66.03 Occlusion and stenosis of bilateral middle cerebral arteries
I66.11 Occlusion and stenosis of right anterior cerebral artery
I66.12 Occlusion and stenosis of left anterior cerebral artery
I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries
I66.21 Occlusion and stenosis of right posterior cerebral artery
I66.22 Occlusion and stenosis of left posterior cerebral artery
I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries
I66.3 Occlusion and stenosis of cerebellar arteries
I66.8 Occlusion and stenosis of other cerebral arteries
I67.1 Cerebral aneurysm, nonruptured
I67.89 Other cerebrovascular disease
I68.2 Cerebral arteritis in other diseases classified elsewhere
I72.0 Aneurysm of carotid artery
I72.5 Aneurysm of other precerebral arteries
I72.6 Aneurysm of vertebral artery
I72.8 Aneurysm of other specified arteries
I76 Septic arterial embolism
I77.0 Arteriovenous fistula, acquired
I77.1 Stricture of artery
I77.2 Rupture of artery
I77.3 Arterial fibromuscular dysplasia
I77.5 Necrosis of artery
I77.6 Arteritis, unspecified
I77.71 Dissection of carotid artery
I77.74 Dissection of vertebral artery
I77.75 Dissection of other precerebral arteries
I77.89 Other specified disorders of arteries and arterioles
I82.C11 Acute embolism and thrombosis of right internal jugular vein
I82.C12 Acute embolism and thrombosis of left internal jugular vein
I82.C13 Acute embolism and thrombosis of internal jugular vein, bilateral
M30.0 Polyarteritis nodosa
M31.5 Giant cell arteritis with polymyalgia rheumatica
M31.6 Other giant cell arteritis
M32.19 Other organ or system involvement in systemic lupus erythematosus
M32.8 Other forms of systemic lupus erythematosus
Q28.2 Arteriovenous malformation of cerebral vessels
Q28.3 Other malformations of cerebral vessels
Q61.3 Polycystic kidney, unspecified
Q85.00 Neurofibromatosis, unspecified
Q85.01 Neurofibromatosis, type 1
Q85.02 Neurofibromatosis, type 2
R22.0 Localized swelling, mass and lump, head
R22.1 Localized swelling, mass and lump, neck
R29.5 Transient paralysis
R29.6* Repeated falls
R29.818* Other symptoms and signs involving the nervous system
R29.898* Other symptoms and signs involving the musculoskeletal system
R42 Dizziness and giddiness
R55 Syncope and collapse
R90.0 Intracranial space-occupying lesion found on diagnostic imaging of central nervous system
R90.82 White matter disease, unspecified
R93.0 Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified
S05.41XA - S05.41XS Penetrating wound of orbit with or without foreign body, right eye, initial encounter - Penetrating wound of orbit with or without foreign body, right eye, sequela
S05.42XA - S05.42XS Penetrating wound of orbit with or without foreign body, left eye, initial encounter - Penetrating wound of orbit with or without foreign body, left eye, sequela
S06.4X0A - S06.4X0S Epidural hemorrhage without loss of consciousness, initial encounter - Epidural hemorrhage without loss of consciousness, sequela
S06.4X1A - S06.4X1S Epidural hemorrhage with loss of consciousness of 30 minutes or less, initial encounter - Epidural hemorrhage with loss of consciousness of 30 minutes or less, sequela
S06.4X2A - S06.4X2S Epidural hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter - Epidural hemorrhage with loss of consciousness of 31 minutes to 59 minutes, sequela
S06.4X3A - S06.4X3S Epidural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter - Epidural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, sequela
S06.4X4A - S06.4X4S Epidural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter - Epidural hemorrhage with loss of consciousness of 6 hours to 24 hours, sequela
S06.4X5A - S06.4X5S Epidural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter - Epidural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, sequela
S06.4X6A - S06.4X6S Epidural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter - Epidural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela
S06.4X9A - S06.4X9S Epidural hemorrhage with loss of consciousness of unspecified duration, initial encounter - Epidural hemorrhage with loss of consciousness of unspecified duration, sequela
S06.5X0A - S06.5X0S Traumatic subdural hemorrhage without loss of consciousness, initial encounter - Traumatic subdural hemorrhage without loss of consciousness, sequela
S06.5X1A - S06.5X1S Traumatic subdural hemorrhage with loss of consciousness of 30 minutes or less, initial encounter - Traumatic subdural hemorrhage with loss of consciousness of 30 minutes or less, sequela
S06.5X2A - S06.5X2S Traumatic subdural hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter - Traumatic subdural hemorrhage with loss of consciousness of 31 minutes to 59 minutes, sequela
S06.5X3A - S06.5X3S Traumatic subdural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter - Traumatic subdural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, sequela
S06.5X4A - S06.5X4S Traumatic subdural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter - Traumatic subdural hemorrhage with loss of consciousness of 6 hours to 24 hours, sequela
S06.5X5A - S06.5X5S Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter - Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, sequela
S06.5X6A - S06.5X6S Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter - Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela
S06.5X9A - S06.5X9S Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter - Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, sequela
S06.6X0A - S06.6X0S Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter - Traumatic subarachnoid hemorrhage without loss of consciousness, sequela
S06.6X1A - S06.6X1S Traumatic subarachnoid hemorrhage with loss of consciousness of 30 minutes or less, initial encounter - Traumatic subarachnoid hemorrhage with loss of consciousness of 30 minutes or less, sequela
S06.6X2A - S06.6X2S Traumatic subarachnoid hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter - Traumatic subarachnoid hemorrhage with loss of consciousness of 31 minutes to 59 minutes, sequela
S06.6X3A - S06.6X3S Traumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter - Traumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, sequela
S06.6X4A - S06.6X4S Traumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter - Traumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, sequela
S06.6X5A - S06.6X5S Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter - Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, sequela
S06.6X6A - S06.6X6S Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter - Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela
S06.6X9A - S06.6X9S Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, initial encounter - Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, sequela
S09.0XXA - S09.0XXS Injury of blood vessels of head, not elsewhere classified, initial encounter - Injury of blood vessels of head, not elsewhere classified, sequela
S15.001A - S15.001S Unspecified injury of right carotid artery, initial encounter - Unspecified injury of right carotid artery, sequela
S15.002A - S15.002S Unspecified injury of left carotid artery, initial encounter - Unspecified injury of left carotid artery, sequela
S15.011A - S15.011S Minor laceration of right carotid artery, initial encounter - Minor laceration of right carotid artery, sequela
S15.012A - S15.012S Minor laceration of left carotid artery, initial encounter - Minor laceration of left carotid artery, sequela
S15.019A - S15.019S Minor laceration of unspecified carotid artery, initial encounter - Minor laceration of unspecified carotid artery, sequela
S15.021A - S15.021S Major laceration of right carotid artery, initial encounter - Major laceration of right carotid artery, sequela
S15.022A - S15.022S Major laceration of left carotid artery, initial encounter - Major laceration of left carotid artery, sequela
S15.029A - S15.029S Major laceration of unspecified carotid artery, initial encounter - Major laceration of unspecified carotid artery, sequela
S15.091A - S15.091S Other specified injury of right carotid artery, initial encounter - Other specified injury of right carotid artery, sequela
S15.092A - S15.092S Other specified injury of left carotid artery, initial encounter - Other specified injury of left carotid artery, sequela
S15.101A - S15.101S Unspecified injury of right vertebral artery, initial encounter - Unspecified injury of right vertebral artery, sequela
S15.102A - S15.102S Unspecified injury of left vertebral artery, initial encounter - Unspecified injury of left vertebral artery, sequela
S15.111A - S15.111S Minor laceration of right vertebral artery, initial encounter - Minor laceration of right vertebral artery, sequela
S15.112A - S15.112S Minor laceration of left vertebral artery, initial encounter - Minor laceration of left vertebral artery, sequela
S15.121A - S15.121S Major laceration of right vertebral artery, initial encounter - Major laceration of right vertebral artery, sequela
S15.122A - S15.122S Major laceration of left vertebral artery, initial encounter - Major laceration of left vertebral artery, sequela
S15.8XXA - S15.8XXS Injury of other specified blood vessels at neck level, initial encounter - Injury of other specified blood vessels at neck level, sequela
T82.311A - T82.311S Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter - Breakdown (mechanical) of carotid arterial graft (bypass), sequela
T82.318A - T82.318S Breakdown (mechanical) of other vascular grafts, initial encounter - Breakdown (mechanical) of other vascular grafts, sequela
T82.321A - T82.321S Displacement of carotid arterial graft (bypass), initial encounter - Displacement of carotid arterial graft (bypass), sequela
T82.328A - T82.328S Displacement of other vascular grafts, initial encounter - Displacement of other vascular grafts, sequela
T82.331A - T82.331S Leakage of carotid arterial graft (bypass), initial encounter - Leakage of carotid arterial graft (bypass), sequela
T82.338A - T82.338S Leakage of other vascular grafts, initial encounter - Leakage of other vascular grafts, sequela
T82.391A - T82.391S Other mechanical complication of carotid arterial graft (bypass), initial encounter - Other mechanical complication of carotid arterial graft (bypass), sequela
T82.398A - T82.398S Other mechanical complication of other vascular grafts, initial encounter - Other mechanical complication of other vascular grafts, sequela
T85.01XA - T85.01XS Breakdown (mechanical) of ventricular intracranial (communicating) shunt, initial encounter - Breakdown (mechanical) of ventricular intracranial (communicating) shunt, sequela
T85.02XA - T85.02XS Displacement of ventricular intracranial (communicating) shunt, initial encounter - Displacement of ventricular intracranial (communicating) shunt, sequela
T85.03XA - T85.03XS Leakage of ventricular intracranial (communicating) shunt, initial encounter - Leakage of ventricular intracranial (communicating) shunt, sequela
T85.09XA - T85.09XS Other mechanical complication of ventricular intracranial (communicating) shunt, initial encounter - Other mechanical complication of ventricular intracranial (communicating) shunt, sequela
T85.110A - T85.110S Breakdown (mechanical) of implanted electronic neurostimulator of brain electrode (lead), initial encounter - Breakdown (mechanical) of implanted electronic neurostimulator of brain electrode (lead), sequela
T85.118A - T85.118S Breakdown (mechanical) of other implanted electronic stimulator of nervous system, initial encounter - Breakdown (mechanical) of other implanted electronic stimulator of nervous system, sequela
T85.120A - T85.120S Displacement of implanted electronic neurostimulator of brain electrode (lead), initial encounter - Displacement of implanted electronic neurostimulator of brain electrode (lead), sequela
T85.128A - T85.128S Displacement of other implanted electronic stimulator of nervous system, initial encounter - Displacement of other implanted electronic stimulator of nervous system, sequela
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Report these codes for patients presenting with signs and symptoms strongly suggesting an intracerebral aneurysm, without the MRA finding of an aneurysm.

Group 2

(251 Codes)
Group 2 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 73725, C8912, C8913, C8914.

Group 2 Codes
Code Description
D18.09 Hemangioma of other sites
E08.51 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene
E08.52 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene
E08.59 Diabetes mellitus due to underlying condition with other circulatory complications
E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E10.52 Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.59 Type 1 diabetes mellitus with other circulatory complications
E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.59 Type 2 diabetes mellitus with other circulatory complications
E13.51 Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene
E13.52 Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene
I70.201 Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg
I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.311 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.312 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.313 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.321 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, right leg
I70.322 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, left leg
I70.323 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, bilateral legs
I70.331 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of thigh
I70.332 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of calf
I70.333 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of ankle
I70.334 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.341 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of thigh
I70.342 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of calf
I70.343 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of ankle
I70.344 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.361 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, right leg
I70.362 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, left leg
I70.363 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, bilateral legs
I70.411 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg
I70.412 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, left leg
I70.413 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.421 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg
I70.422 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, left leg
I70.423 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs
I70.431 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh
I70.432 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of calf
I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle
I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.441 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh
I70.442 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of calf
I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle
I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.461 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg
I70.462 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, left leg
I70.463 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs
I70.511 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.512 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.513 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.521 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg
I70.522 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, left leg
I70.523 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.531 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh
I70.532 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of calf
I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle
I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.541 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh
I70.542 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of calf
I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle
I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.561 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg
I70.562 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, left leg
I70.563 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.611 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.612 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.613 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.621 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, right leg
I70.622 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, left leg
I70.623 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.631 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh
I70.632 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of calf
I70.633 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle
I70.634 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.641 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh
I70.642 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of calf
I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle
I70.644 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.661 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, right leg
I70.662 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, left leg
I70.663 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, bilateral legs
I72.3 Aneurysm of iliac artery
I72.4 Aneurysm of artery of lower extremity
I73.01 Raynaud's syndrome with gangrene
I73.1 Thromboangiitis obliterans [Buerger's disease]
I73.9 Peripheral vascular disease, unspecified
I74.3 Embolism and thrombosis of arteries of the lower extremities
I74.5 Embolism and thrombosis of iliac artery
I74.8 Embolism and thrombosis of other arteries
I75.021 Atheroembolism of right lower extremity
I75.022 Atheroembolism of left lower extremity
I75.023 Atheroembolism of bilateral lower extremities
I76 Septic arterial embolism
I77.1 Stricture of artery
I77.3 Arterial fibromuscular dysplasia
I77.5 Necrosis of artery
I77.6 Arteritis, unspecified
I77.72 Dissection of iliac artery
I77.79 Dissection of other specified artery
I77.89 Other specified disorders of arteries and arterioles
I79.1 Aortitis in diseases classified elsewhere
I79.8 Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere
I96 Gangrene, not elsewhere classified
Q27.32 Arteriovenous malformation of vessel of lower limb
Q27.39 Arteriovenous malformation, other site
S75.011A - S75.011S Minor laceration of femoral artery, right leg, initial encounter - Minor laceration of femoral artery, right leg, sequela
S75.012A - S75.012S Minor laceration of femoral artery, left leg, initial encounter - Minor laceration of femoral artery, left leg, sequela
S75.021A - S75.021S Major laceration of femoral artery, right leg, initial encounter - Major laceration of femoral artery, right leg, sequela
S75.022A - S75.022S Major laceration of femoral artery, left leg, initial encounter - Major laceration of femoral artery, left leg, sequela
S77.01XA - S77.01XS Crushing injury of right hip, initial encounter - Crushing injury of right hip, sequela
S77.02XA - S77.02XS Crushing injury of left hip, initial encounter - Crushing injury of left hip, sequela
S77.11XA - S77.11XS Crushing injury of right thigh, initial encounter - Crushing injury of right thigh, sequela
S77.12XA - S77.12XS Crushing injury of left thigh, initial encounter - Crushing injury of left thigh, sequela
S77.21XA - S77.21XS Crushing injury of right hip with thigh, initial encounter - Crushing injury of right hip with thigh, sequela
S77.22XA - S77.22XS Crushing injury of left hip with thigh, initial encounter - Crushing injury of left hip with thigh, sequela
S85.011A - S85.011S Laceration of popliteal artery, right leg, initial encounter - Laceration of popliteal artery, right leg, sequela
S85.012A - S85.012S Laceration of popliteal artery, left leg, initial encounter - Laceration of popliteal artery, left leg, sequela
S85.091A - S85.091S Other specified injury of popliteal artery, right leg, initial encounter - Other specified injury of popliteal artery, right leg, sequela
S85.092A - S85.092S Other specified injury of popliteal artery, left leg, initial encounter - Other specified injury of popliteal artery, left leg, sequela
S85.141A - S85.141S Laceration of anterior tibial artery, right leg, initial encounter - Laceration of anterior tibial artery, right leg, sequela
S85.142A - S85.142S Laceration of anterior tibial artery, left leg, initial encounter - Laceration of anterior tibial artery, left leg, sequela
S85.151A - S85.151S Other specified injury of anterior tibial artery, right leg, initial encounter - Other specified injury of anterior tibial artery, right leg, sequela
S85.152A - S85.152S Other specified injury of anterior tibial artery, left leg, initial encounter - Other specified injury of anterior tibial artery, left leg, sequela
S85.171A - S85.171S Laceration of posterior tibial artery, right leg, initial encounter - Laceration of posterior tibial artery, right leg, sequela
S85.172A - S85.172S Laceration of posterior tibial artery, left leg, initial encounter - Laceration of posterior tibial artery, left leg, sequela
S85.181A - S85.181S Other specified injury of posterior tibial artery, right leg, initial encounter - Other specified injury of posterior tibial artery, right leg, sequela
S85.182A - S85.182S Other specified injury of posterior tibial artery, left leg, initial encounter - Other specified injury of posterior tibial artery, left leg, sequela
S87.01XA - S87.01XS Crushing injury of right knee, initial encounter - Crushing injury of right knee, sequela
S87.02XA - S87.02XS Crushing injury of left knee, initial encounter - Crushing injury of left knee, sequela
S87.81XA - S87.81XS Crushing injury of right lower leg, initial encounter - Crushing injury of right lower leg, sequela
S87.82XA - S87.82XS Crushing injury of left lower leg, initial encounter - Crushing injury of left lower leg, sequela
S97.01XA - S97.01XS Crushing injury of right ankle, initial encounter - Crushing injury of right ankle, sequela
S97.02XA - S97.02XS Crushing injury of left ankle, initial encounter - Crushing injury of left ankle, sequela
S97.111A - S97.111S Crushing injury of right great toe, initial encounter - Crushing injury of right great toe, sequela
S97.112A - S97.112S Crushing injury of left great toe, initial encounter - Crushing injury of left great toe, sequela
S97.121A - S97.121S Crushing injury of right lesser toe(s), initial encounter - Crushing injury of right lesser toe(s), sequela
S97.122A - S97.122S Crushing injury of left lesser toe(s), initial encounter - Crushing injury of left lesser toe(s), sequela
S97.81XA - S97.81XS Crushing injury of right foot, initial encounter - Crushing injury of right foot, sequela
S97.82XA - S97.82XS Crushing injury of left foot, initial encounter - Crushing injury of left foot, sequela
T82.311A - T82.311S Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter - Breakdown (mechanical) of carotid arterial graft (bypass), sequela
T82.318A - T82.318S Breakdown (mechanical) of other vascular grafts, initial encounter - Breakdown (mechanical) of other vascular grafts, sequela
T82.321A - T82.321S Displacement of carotid arterial graft (bypass), initial encounter - Displacement of carotid arterial graft (bypass), sequela
T82.328A - T82.328S Displacement of other vascular grafts, initial encounter - Displacement of other vascular grafts, sequela
T82.331A - T82.331S Leakage of carotid arterial graft (bypass), initial encounter - Leakage of carotid arterial graft (bypass), sequela
T82.338A - T82.338S Leakage of other vascular grafts, initial encounter - Leakage of other vascular grafts, sequela
T82.391A - T82.391S Other mechanical complication of carotid arterial graft (bypass), initial encounter - Other mechanical complication of carotid arterial graft (bypass), sequela
T82.398A - T82.398S Other mechanical complication of other vascular grafts, initial encounter - Other mechanical complication of other vascular grafts, sequela
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm

Group 3

(241 Codes)
Group 3 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 74185, 72198, C8900, C8901, C8902, C8918, C8919, and C8920.

Group 3 Codes
Code Description
C64.1 Malignant neoplasm of right kidney, except renal pelvis
C64.2 Malignant neoplasm of left kidney, except renal pelvis
C65.1 Malignant neoplasm of right renal pelvis
C65.2 Malignant neoplasm of left renal pelvis
C68.8 Malignant neoplasm of overlapping sites of urinary organs
D30.01 Benign neoplasm of right kidney
D30.02 Benign neoplasm of left kidney
I10 Essential (primary) hypertension
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I15.0 Renovascular hypertension
I15.1 Hypertension secondary to other renal disorders
I1A.0 Resistant hypertension
I70.0 Atherosclerosis of aorta
I70.1 Atherosclerosis of renal artery
I70.201 Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg
I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I71.02 Dissection of abdominal aorta
I71.03 Dissection of thoracoabdominal aorta
I71.40 Abdominal aortic aneurysm, without rupture, unspecified
I71.41 Pararenal abdominal aortic aneurysm, without rupture
I71.42 Juxtarenal abdominal aortic aneurysm, without rupture
I71.43 Infrarenal abdominal aortic aneurysm, without rupture
I71.60 Thoracoabdominal aortic aneurysm, without rupture, unspecified
I71.61 Supraceliac aneurysm of the thoracoabdominal aorta, without rupture
I71.62 Paravisceral aneurysm of the thoracoabdominal aorta, without rupture
I71.9 Aortic aneurysm of unspecified site, without rupture
I72.2 Aneurysm of renal artery
I72.3 Aneurysm of iliac artery
I72.4 Aneurysm of artery of lower extremity
I72.8 Aneurysm of other specified arteries
I73.9 Peripheral vascular disease, unspecified
I74.01 Saddle embolus of abdominal aorta
I74.09 Other arterial embolism and thrombosis of abdominal aorta
I74.11 Embolism and thrombosis of thoracic aorta
I74.5 Embolism and thrombosis of iliac artery
I75.81 Atheroembolism of kidney
I76 Septic arterial embolism
I77.0 Arteriovenous fistula, acquired
I77.1 Stricture of artery
I77.3 Arterial fibromuscular dysplasia
I77.4 Celiac artery compression syndrome
I77.5 Necrosis of artery
I77.72 Dissection of iliac artery
I77.73 Dissection of renal artery
I77.89 Other specified disorders of arteries and arterioles
K55.011 Focal (segmental) acute (reversible) ischemia of small intestine
K55.012 Diffuse acute (reversible) ischemia of small intestine
K55.031 Focal (segmental) acute (reversible) ischemia of large intestine
K55.032 Diffuse acute (reversible) ischemia of large intestine
K55.1 Chronic vascular disorders of intestine
N17.0 Acute kidney failure with tubular necrosis
N17.1 Acute kidney failure with acute cortical necrosis
N17.2 Acute kidney failure with medullary necrosis
N17.8 Other acute kidney failure
N17.9 Acute kidney failure, unspecified
N18.1 Chronic kidney disease, stage 1
N18.2 Chronic kidney disease, stage 2 (mild)
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N18.6 End stage renal disease
N18.9 Chronic kidney disease, unspecified
N26.9 Renal sclerosis, unspecified
N27.0 Small kidney, unilateral
N27.1 Small kidney, bilateral
N27.9 Small kidney, unspecified
N28.0 Ischemia and infarction of kidney
Q27.1 Congenital renal artery stenosis
Q27.2 Other congenital malformations of renal artery
Q27.34 Arteriovenous malformation of renal vessel
R93.5 Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum
S31.001A - S31.001S Unspecified open wound of lower back and pelvis with penetration into retroperitoneum, initial encounter - Unspecified open wound of lower back and pelvis with penetration into retroperitoneum, sequela
S35.01XA - S35.01XS Minor laceration of abdominal aorta, initial encounter - Minor laceration of abdominal aorta, sequela
S35.02XA - S35.02XS Major laceration of abdominal aorta, initial encounter - Major laceration of abdominal aorta, sequela
S35.09XA - S35.09XS Other injury of abdominal aorta, initial encounter - Other injury of abdominal aorta, sequela
S35.411A - S35.411S Laceration of right renal artery, initial encounter - Laceration of right renal artery, sequela
S35.412A - S35.412S Laceration of left renal artery, initial encounter - Laceration of left renal artery, sequela
S35.413A - S35.413S Laceration of unspecified renal artery, initial encounter - Laceration of unspecified renal artery, sequela
S35.416A - S35.416S Laceration of unspecified renal vein, initial encounter - Laceration of unspecified renal vein, sequela
S35.491A - S35.491S Other specified injury of right renal artery, initial encounter - Other specified injury of right renal artery, sequela
S35.492A - S35.492S Other specified injury of left renal artery, initial encounter - Other specified injury of left renal artery, sequela
S35.493A - S35.493S Other specified injury of unspecified renal artery, initial encounter - Other specified injury of unspecified renal artery, sequela
S35.496A - S35.496S Other specified injury of unspecified renal vein, initial encounter - Other specified injury of unspecified renal vein, sequela
S35.511A - S35.511S Injury of right iliac artery, initial encounter - Injury of right iliac artery, sequela
S35.512A - S35.512S Injury of left iliac artery, initial encounter - Injury of left iliac artery, sequela
S35.513A - S35.513S Injury of unspecified iliac artery, initial encounter - Injury of unspecified iliac artery, sequela
S37.001A - S37.001S Unspecified injury of right kidney, initial encounter - Unspecified injury of right kidney, sequela
S37.002A - S37.002S Unspecified injury of left kidney, initial encounter - Unspecified injury of left kidney, sequela
S37.011A - S37.011S Minor contusion of right kidney, initial encounter - Minor contusion of right kidney, sequela
S37.012A - S37.012S Minor contusion of left kidney, initial encounter - Minor contusion of left kidney, sequela
S37.021A - S37.021S Major contusion of right kidney, initial encounter - Major contusion of right kidney, sequela
S37.022A - S37.022S Major contusion of left kidney, initial encounter - Major contusion of left kidney, sequela
S37.031A - S37.031S Laceration of right kidney, unspecified degree, initial encounter - Laceration of right kidney, unspecified degree, sequela
S37.032A - S37.032S Laceration of left kidney, unspecified degree, initial encounter - Laceration of left kidney, unspecified degree, sequela
S37.041A - S37.041S Minor laceration of right kidney, initial encounter - Minor laceration of right kidney, sequela
S37.042A - S37.042S Minor laceration of left kidney, initial encounter - Minor laceration of left kidney, sequela
S37.051A - S37.051S Moderate laceration of right kidney, initial encounter - Moderate laceration of right kidney, sequela
S37.052A - S37.052S Moderate laceration of left kidney, initial encounter - Moderate laceration of left kidney, sequela
S37.061A - S37.061S Major laceration of right kidney, initial encounter - Major laceration of right kidney, sequela
S37.062A - S37.062S Major laceration of left kidney, initial encounter - Major laceration of left kidney, sequela
T81.711A - T81.711S Complication of renal artery following a procedure, not elsewhere classified, initial encounter - Complication of renal artery following a procedure, not elsewhere classified, sequela
T82.311A - T82.311S Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter - Breakdown (mechanical) of carotid arterial graft (bypass), sequela
T82.318A - T82.318S Breakdown (mechanical) of other vascular grafts, initial encounter - Breakdown (mechanical) of other vascular grafts, sequela
T82.321A - T82.321S Displacement of carotid arterial graft (bypass), initial encounter - Displacement of carotid arterial graft (bypass), sequela
T82.328A - T82.328S Displacement of other vascular grafts, initial encounter - Displacement of other vascular grafts, sequela
T82.331A - T82.331S Leakage of carotid arterial graft (bypass), initial encounter - Leakage of carotid arterial graft (bypass), sequela
T82.338A - T82.338S Leakage of other vascular grafts, initial encounter - Leakage of other vascular grafts, sequela
T82.391A - T82.391S Other mechanical complication of carotid arterial graft (bypass), initial encounter - Other mechanical complication of carotid arterial graft (bypass), sequela
T82.398A - T82.398S Other mechanical complication of other vascular grafts, initial encounter - Other mechanical complication of other vascular grafts, sequela
T82.7XXA - T82.7XXS Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter - Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, sequela
T82.818A - T82.818S Embolism due to vascular prosthetic devices, implants and grafts, initial encounter - Embolism due to vascular prosthetic devices, implants and grafts, sequela
T82.828A - T82.828S Fibrosis due to vascular prosthetic devices, implants and grafts, initial encounter - Fibrosis due to vascular prosthetic devices, implants and grafts, sequela
T82.838A - T82.838S Hemorrhage due to vascular prosthetic devices, implants and grafts, initial encounter - Hemorrhage due to vascular prosthetic devices, implants and grafts, sequela
T82.848A - T82.848S Pain due to vascular prosthetic devices, implants and grafts, initial encounter - Pain due to vascular prosthetic devices, implants and grafts, sequela
T82.858A - T82.858S Stenosis of other vascular prosthetic devices, implants and grafts, initial encounter - Stenosis of other vascular prosthetic devices, implants and grafts, sequela
T82.868A - T82.868S Thrombosis due to vascular prosthetic devices, implants and grafts, initial encounter - Thrombosis due to vascular prosthetic devices, implants and grafts, sequela
T86.11 Kidney transplant rejection
T86.12 Kidney transplant failure
T86.13 Kidney transplant infection
T86.890 Other transplanted tissue rejection
T86.891 Other transplanted tissue failure
T86.892 Other transplanted tissue infection
Z00.5 Encounter for examination of potential donor of organ and tissue
Z48.22 Encounter for aftercare following kidney transplant
Z48.812 Encounter for surgical aftercare following surgery on the circulatory system
Z52.4 Kidney donor
Z94.0 Kidney transplant status

Group 4

(67 Codes)
Group 4 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 71555, C8909, C8910, C8911.

Group 4 Codes
Code Description
A52.01 Syphilitic aneurysm of aorta
I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.09 Other pulmonary embolism with acute cor pulmonale
I26.90 Septic pulmonary embolism without acute cor pulmonale
I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
I26.99 Other pulmonary embolism without acute cor pulmonale
I28.1 Aneurysm of pulmonary artery
I71.010 Dissection of ascending aorta
I71.011 Dissection of aortic arch
I71.012 Dissection of descending thoracic aorta
I71.019 Dissection of thoracic aorta, unspecified
I71.03 Dissection of thoracoabdominal aorta
I71.20 Thoracic aortic aneurysm, without rupture, unspecified
I71.21 Aneurysm of the ascending aorta, without rupture
I71.22 Aneurysm of the aortic arch, without rupture
I71.23 Aneurysm of the descending thoracic aorta, without rupture
I71.60 Thoracoabdominal aortic aneurysm, without rupture, unspecified
I71.61 Supraceliac aneurysm of the thoracoabdominal aorta, without rupture
I71.62 Paravisceral aneurysm of the thoracoabdominal aorta, without rupture
I71.9 Aortic aneurysm of unspecified site, without rupture
I74.11 Embolism and thrombosis of thoracic aorta
I76 Septic arterial embolism
M31.4 Aortic arch syndrome [Takayasu]
N17.9 Acute kidney failure, unspecified
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N18.6 End stage renal disease
N19 Unspecified kidney failure
Q25.1 Coarctation of aorta
Q25.21 Interruption of aortic arch
Q25.29 Other atresia of aorta
Q87.410 Marfan syndrome with aortic dilation
Q87.418 Marfan syndrome with other cardiovascular manifestations
R07.1 Chest pain on breathing
R07.2 Precordial pain
R07.81 Pleurodynia
R07.82 Intercostal pain
R07.89 Other chest pain
R07.9 Chest pain, unspecified
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation
R94.2 Abnormal results of pulmonary function studies
T80.0XXA - T80.0XXS Air embolism following infusion, transfusion and therapeutic injection, initial encounter - Air embolism following infusion, transfusion and therapeutic injection, sequela
T81.718A - T81.718S Complication of other artery following a procedure, not elsewhere classified, initial encounter - Complication of other artery following a procedure, not elsewhere classified, sequela
T81.72XA - T81.72XS Complication of vein following a procedure, not elsewhere classified, initial encounter - Complication of vein following a procedure, not elsewhere classified, sequela
T82.817A - T82.817S Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter - Embolism due to cardiac prosthetic devices, implants and grafts, sequela
T82.818A - T82.818S Embolism due to vascular prosthetic devices, implants and grafts, initial encounter - Embolism due to vascular prosthetic devices, implants and grafts, sequela
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z85.01 Personal history of malignant neoplasm of esophagus
Z86.79 Personal history of other diseases of the circulatory system
Z88.8* Allergy status to other drugs, medicaments and biological substances
Z91.041 Radiographic dye allergy status
Z91.048 Other nonmedicinal substance allergy status
Group 4 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*When billing for personal history of allergy to other specified medicinal agents, report the ICD-10-CM code for pulmonary embolism or abnormal lung scan as the primary diagnosis and Z88.8 as the secondary.

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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
083x Ambulatory Surgery Center
085x Critical Access Hospital
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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, for further guidance.


Code Description
0615 Magnetic Resonance Technology (MRT) - MRA - Head and Neck
0616 Magnetic Resonance Technology (MRT) - MRA - Lower Extremities
0618 Magnetic Resonance Technology (MRT) - MRA - Other
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Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2023 R5

Article revised and published on 10/26/2023 effective for dates of service on and after 10/01/2023 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes in ‘Group 3 codes’ have been revised: I71.61, I71.62. The following ICD-10-CM codes in ‘Group 4 codes’ have been revised: I71.61, I71.62,Q87.410, Q87.418. The following ICD-10-CM code has been added to ‘Group 3 codes’: I1A.0.

10/01/2022 R4

Article revised and published on 10/20/2022 effective for dates of service on and after 10/01/2022 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been deleted and therefore have been removed from the article: F01.51 from ICD-10-CM Codes that Support Medical Necessity Group 1; I71.4 and I71.6 from ICD-10-CM Codes that Support Medical Necessity Group 3; I71.01, I71.2 and I71.6 from ICD-10-CM Codes that Support Medical Necessity Group 4. The following ICD-10-CM codes have been added to the Article: F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4 to ICD-10-CM Codes that Support Medical Necessity Group 1; I71.40, I71.41, I71.42, I71.43, I71.60, I71.61, I71.62 to ICD-10-CM Codes that Support Medical Necessity Group 3; I71.010, I71.011, I71.012, I71.019, I71.20, I71.21, I71.22, I71.23, I71.60, I71.61, I71.62 to ICD-10-CM Codes that Support Medical Necessity Group 4. ICD-10-CM code F01.50 has undergone a code description change.

10/01/2020 R3

Article revised and published on 10/01/2020 effective for dates of service on and after 10/01/2020 to reflect the annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been added to the Article: N18.31, N18.32 have been added to ICD-10-CM code groups 3 and 4. The following ICD-10-CM code has been deleted and therefore has been removed from the article: N18.3 has been deleted from ICD-10-CM code groups 3 and 4. The following ICD-10-CM code has undergone a descriptor change in Code Group 4: Z88.8. Minor formatting changes were made to the Social Security Act (Title XVIII) Standard References and documentation requirements have been added.

07/01/2020 R2

Article revised and published on 06/25/2020 effective for dates of service on and after 07/01/2020 as a non-discretionary update to remove the Group 5 Paragraph-Non-Covered Services, language indicating ICD-10-CM Codes do not support the medical necessity for the CPT codes listed below as they are always non-covered, and the Group 5 Table of Non-Covered CPT/HCPCS Codes.

 

10/01/2019 R1

Article revised and published on 10/17/2019 effective for dates of service on or after 10/01/2019 to reflect the annual ICD-10-CM updates. The following ICD-10-CM code has been added to Group 1: H81.4. The following ICD-10-CM codes have been deleted from Group 1: H81.41, H81.42 and H81.43. The following ICD-10-CM codes have been added to Group 4: I26.93 and I26.94. The notes in ICD-10 Code Group 1 and 4 Paragraphs have been placed at the bottom of the codes in the asterisk explanations and asterisks have been added next to the appropriate codes within the tables. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34865 - Magnetic Resonance Angiography (MRA)
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
10/20/2023 10/01/2023 - N/A Currently in Effect You are here
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Keywords

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