LCD Reference Article Billing and Coding Article

Billing and Coding: Urine Drug Testing

A56818

Expand All | Collapse All
Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website.
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.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56818
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Urine Drug Testing
Article Type
Billing and Coding
Original Effective Date
08/08/2019
Revision Effective Date
03/05/2026
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. 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. CPT is a registered trademark of the American Medical Association.

Current Dental Terminology © 2025 American Dental Association. All rights reserved.

Copyright © 2025, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at ub04@aha.org or 312‐422‐3366.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1.2 - A/B MAC (B) Contacts with Independent Clinical Laboratories

 

Article Guidance

Article Text

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD L36029 Urine Drug Testing.

A qualitative/presumptive drug screen is used to detect the presence of a drug in the body. A blood, urine, or oral fluid sample may be used. However, urine is the best specimen for broad screening, as blood is relatively insensitive for many common drugs, including psychotropic agents, opioids, and stimulants.

Common methods of drug analysis include chromatography, immunoassay, chemical ("spot") tests, and spectrometry.

 

Coding Guidelines

One presumptive drug testing code may be billed once per patient per day as indicated by the code description and should only be billed at one unit regardless of the provider.

 

One definitive drug testing code may be billed once per patient per day as indicated by the code description and should only be billed at one unit regardless of the provider.

The documentation should support the medical necessity of the drug testing ordered and should support the clinical indicators that led to ordering the test.

Documentation Requirements

  1. All documentation must be maintained in the patient’s medical record and available to the contractor upon request.
  1. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The record must include the identity of the physician or non-physician practitioner responsible for and providing the care to the patient.
  2. The submitted medical record should support the use of the selected diagnosis code(s). The submitted CPT/HCPCS code should describe the service performed.
  3. Medical record documentation (e.g., history and physical, progress notes) maintained by the ordering physician/treating physician must indicate the medical necessity for performing a drug test. All tests must be ordered in writing by the treating provider and all drugs/drug classes to be tested must be indicated in the order.
  1. If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of the lab results, along with copies of the ordering/referring physician’s order for the drug test. The physician must include the clinical indication/medical necessity in the order for the drug test.

This LCD does not apply to acute inpatient claims.

Claims for drug screening services are payable under Medicare Part B in the following places of service: office (11), urgent care (20), independent clinic (49), federally qualified health center (freestanding) (50), rural health clinic (freestanding) (72), and independent laboratory (81).

All services/procedures performed on the same day for the same beneficiary by the physician/provider should be billed on the same claim.

All coverage criteria must be met before Medicare can reimburse this service.

Billing for these services in a non-covered situation (e.g., does not meet indications of the LCD) will generally require an Advance Beneficiary Notice (ABN) be obtained before the service is rendered.

Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item, or procedure may not be covered by Medicare.

The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category, or is rendered for screening purposes.

 

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

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

(808 Codes)
Group 1 Paragraph

G0480, G0481, G0482, G0483, G0659, 80305, 80306, 80307.

Diagnosis codes must be coded to the highest level of specificity.

For codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequela may be used.

Group 1 Codes
Code Description
E87.20 Acidosis, unspecified
E87.21 Acute metabolic acidosis
E87.22 Chronic metabolic acidosis
E87.29 Other acidosis
F10.11 Alcohol abuse, in remission
F10.20 Alcohol dependence, uncomplicated
F11.10 Opioid abuse, uncomplicated
F11.11 Opioid abuse, in remission
F11.120 Opioid abuse with intoxication, uncomplicated
F11.121 Opioid abuse with intoxication delirium
F11.122 Opioid abuse with intoxication with perceptual disturbance
F11.129 Opioid abuse with intoxication, unspecified
F11.13 Opioid abuse with withdrawal
F11.14 Opioid abuse with opioid-induced mood disorder
F11.150 Opioid abuse with opioid-induced psychotic disorder with delusions
F11.151 Opioid abuse with opioid-induced psychotic disorder with hallucinations
F11.159 Opioid abuse with opioid-induced psychotic disorder, unspecified
F11.181 Opioid abuse with opioid-induced sexual dysfunction
F11.182 Opioid abuse with opioid-induced sleep disorder
F11.188 Opioid abuse with other opioid-induced disorder
F11.19 Opioid abuse with unspecified opioid-induced disorder
F11.20 Opioid dependence, uncomplicated
F11.21 Opioid dependence, in remission
F11.220 Opioid dependence with intoxication, uncomplicated
F11.221 Opioid dependence with intoxication delirium
F11.222 Opioid dependence with intoxication with perceptual disturbance
F11.229 Opioid dependence with intoxication, unspecified
F11.23 Opioid dependence with withdrawal
F11.24 Opioid dependence with opioid-induced mood disorder
F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions
F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations
F11.259 Opioid dependence with opioid-induced psychotic disorder, unspecified
F11.281 Opioid dependence with opioid-induced sexual dysfunction
F11.282 Opioid dependence with opioid-induced sleep disorder
F11.288 Opioid dependence with other opioid-induced disorder
F11.29 Opioid dependence with unspecified opioid-induced disorder
F11.90 Opioid use, unspecified, uncomplicated
F11.91 Opioid use, unspecified, in remission
F11.920 Opioid use, unspecified with intoxication, uncomplicated
F11.921 Opioid use, unspecified with intoxication delirium
F11.922 Opioid use, unspecified with intoxication with perceptual disturbance
F11.929 Opioid use, unspecified with intoxication, unspecified
F11.93 Opioid use, unspecified with withdrawal
F11.94 Opioid use, unspecified with opioid-induced mood disorder
F11.950 Opioid use, unspecified with opioid-induced psychotic disorder with delusions
F11.951 Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations
F11.959 Opioid use, unspecified with opioid-induced psychotic disorder, unspecified
F11.981 Opioid use, unspecified with opioid-induced sexual dysfunction
F11.982 Opioid use, unspecified with opioid-induced sleep disorder
F11.988 Opioid use, unspecified with other opioid-induced disorder
F11.99 Opioid use, unspecified with unspecified opioid-induced disorder
F12.10 Cannabis abuse, uncomplicated
F12.11 Cannabis abuse, in remission
F12.120 Cannabis abuse with intoxication, uncomplicated
F12.121 Cannabis abuse with intoxication delirium
F12.122 Cannabis abuse with intoxication with perceptual disturbance
F12.129 Cannabis abuse with intoxication, unspecified
F12.13 Cannabis abuse with withdrawal
F12.150 Cannabis abuse with psychotic disorder with delusions
F12.151 Cannabis abuse with psychotic disorder with hallucinations
F12.159 Cannabis abuse with psychotic disorder, unspecified
F12.180 Cannabis abuse with cannabis-induced anxiety disorder
F12.188 Cannabis abuse with other cannabis-induced disorder
F12.19 Cannabis abuse with unspecified cannabis-induced disorder
F12.20 Cannabis dependence, uncomplicated
F12.21 Cannabis dependence, in remission
F12.220 Cannabis dependence with intoxication, uncomplicated
F12.221 Cannabis dependence with intoxication delirium
F12.222 Cannabis dependence with intoxication with perceptual disturbance
F12.229 Cannabis dependence with intoxication, unspecified
F12.23 Cannabis dependence with withdrawal
F12.250 Cannabis dependence with psychotic disorder with delusions
F12.251 Cannabis dependence with psychotic disorder with hallucinations
F12.259 Cannabis dependence with psychotic disorder, unspecified
F12.280 Cannabis dependence with cannabis-induced anxiety disorder
F12.288 Cannabis dependence with other cannabis-induced disorder
F12.29 Cannabis dependence with unspecified cannabis-induced disorder
F12.90 Cannabis use, unspecified, uncomplicated
F12.91 Cannabis use, unspecified, in remission
F12.920 Cannabis use, unspecified with intoxication, uncomplicated
F12.921 Cannabis use, unspecified with intoxication delirium
F12.922 Cannabis use, unspecified with intoxication with perceptual disturbance
F12.929 Cannabis use, unspecified with intoxication, unspecified
F12.93 Cannabis use, unspecified with withdrawal
F12.950 Cannabis use, unspecified with psychotic disorder with delusions
F12.951 Cannabis use, unspecified with psychotic disorder with hallucinations
F12.959 Cannabis use, unspecified with psychotic disorder, unspecified
F12.980 Cannabis use, unspecified with anxiety disorder
F12.988 Cannabis use, unspecified with other cannabis-induced disorder
F12.99 Cannabis use, unspecified with unspecified cannabis-induced disorder
F13.10 Sedative, hypnotic or anxiolytic abuse, uncomplicated
F13.11 Sedative, hypnotic or anxiolytic abuse, in remission
F13.120 Sedative, hypnotic or anxiolytic abuse with intoxication, uncomplicated
F13.121 Sedative, hypnotic or anxiolytic abuse with intoxication delirium
F13.129 Sedative, hypnotic or anxiolytic abuse with intoxication, unspecified
F13.130 Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated
F13.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium
F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance
F13.139 Sedative, hypnotic or anxiolytic abuse with withdrawal, unspecified
F13.14 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced mood disorder
F13.150 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.151 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.159 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.180 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced anxiety disorder
F13.181 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sexual dysfunction
F13.182 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sleep disorder
F13.188 Sedative, hypnotic or anxiolytic abuse with other sedative, hypnotic or anxiolytic-induced disorder
F13.19 Sedative, hypnotic or anxiolytic abuse with unspecified sedative, hypnotic or anxiolytic-induced disorder
F13.20 Sedative, hypnotic or anxiolytic dependence, uncomplicated
F13.21 Sedative, hypnotic or anxiolytic dependence, in remission
F13.220 Sedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated
F13.221 Sedative, hypnotic or anxiolytic dependence with intoxication delirium
F13.229 Sedative, hypnotic or anxiolytic dependence with intoxication, unspecified
F13.230 Sedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated
F13.231 Sedative, hypnotic or anxiolytic dependence with withdrawal delirium
F13.232 Sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance
F13.239 Sedative, hypnotic or anxiolytic dependence with withdrawal, unspecified
F13.24 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder
F13.250 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.251 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.259 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.26 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder
F13.27 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia
F13.280 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced anxiety disorder
F13.281 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sexual dysfunction
F13.282 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sleep disorder
F13.288 Sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorder
F13.29 Sedative, hypnotic or anxiolytic dependence with unspecified sedative, hypnotic or anxiolytic-induced disorder
F13.90 Sedative, hypnotic, or anxiolytic use, unspecified, uncomplicated
F13.91 Sedative, hypnotic or anxiolytic use, unspecified, in remission
F13.920 Sedative, hypnotic or anxiolytic use, unspecified with intoxication, uncomplicated
F13.921 Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium
F13.929 Sedative, hypnotic or anxiolytic use, unspecified with intoxication, unspecified
F13.930 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal, uncomplicated
F13.931 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal delirium
F13.932 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal with perceptual disturbances
F13.939 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal, unspecified
F13.94 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced mood disorder
F13.950 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.951 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.959 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.96 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder
F13.97 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia
F13.980 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced anxiety disorder
F13.981 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sexual dysfunction
F13.982 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sleep disorder
F13.988 Sedative, hypnotic or anxiolytic use, unspecified with other sedative, hypnotic or anxiolytic-induced disorder
F13.99 Sedative, hypnotic or anxiolytic use, unspecified with unspecified sedative, hypnotic or anxiolytic-induced disorder
F14.10 Cocaine abuse, uncomplicated
F14.11 Cocaine abuse, in remission
F14.120 Cocaine abuse with intoxication, uncomplicated
F14.121 Cocaine abuse with intoxication with delirium
F14.122 Cocaine abuse with intoxication with perceptual disturbance
F14.129 Cocaine abuse with intoxication, unspecified
F14.13 Cocaine abuse, unspecified with withdrawal
F14.14 Cocaine abuse with cocaine-induced mood disorder
F14.150 Cocaine abuse with cocaine-induced psychotic disorder with delusions
F14.151 Cocaine abuse with cocaine-induced psychotic disorder with hallucinations
F14.159 Cocaine abuse with cocaine-induced psychotic disorder, unspecified
F14.180 Cocaine abuse with cocaine-induced anxiety disorder
F14.181 Cocaine abuse with cocaine-induced sexual dysfunction
F14.182 Cocaine abuse with cocaine-induced sleep disorder
F14.188 Cocaine abuse with other cocaine-induced disorder
F14.19 Cocaine abuse with unspecified cocaine-induced disorder
F14.20 Cocaine dependence, uncomplicated
F14.21 Cocaine dependence, in remission
F14.220 Cocaine dependence with intoxication, uncomplicated
F14.221 Cocaine dependence with intoxication delirium
F14.222 Cocaine dependence with intoxication with perceptual disturbance
F14.229 Cocaine dependence with intoxication, unspecified
F14.23 Cocaine dependence with withdrawal
F14.24 Cocaine dependence with cocaine-induced mood disorder
F14.250 Cocaine dependence with cocaine-induced psychotic disorder with delusions
F14.251 Cocaine dependence with cocaine-induced psychotic disorder with hallucinations
F14.259 Cocaine dependence with cocaine-induced psychotic disorder, unspecified
F14.280 Cocaine dependence with cocaine-induced anxiety disorder
F14.281 Cocaine dependence with cocaine-induced sexual dysfunction
F14.282 Cocaine dependence with cocaine-induced sleep disorder
F14.288 Cocaine dependence with other cocaine-induced disorder
F14.29 Cocaine dependence with unspecified cocaine-induced disorder
F14.90 Cocaine use, unspecified, uncomplicated
F14.91 Cocaine use, unspecified, in remission
F14.920 Cocaine use, unspecified with intoxication, uncomplicated
F14.921 Cocaine use, unspecified with intoxication delirium
F14.922 Cocaine use, unspecified with intoxication with perceptual disturbance
F14.929 Cocaine use, unspecified with intoxication, unspecified
F14.93 Cocaine use, unspecified with withdrawal
F14.94 Cocaine use, unspecified with cocaine-induced mood disorder
F14.950 Cocaine use, unspecified with cocaine-induced psychotic disorder with delusions
F14.951 Cocaine use, unspecified with cocaine-induced psychotic disorder with hallucinations
F14.959 Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified
F14.980 Cocaine use, unspecified with cocaine-induced anxiety disorder
F14.981 Cocaine use, unspecified with cocaine-induced sexual dysfunction
F14.982 Cocaine use, unspecified with cocaine-induced sleep disorder
F14.988 Cocaine use, unspecified with other cocaine-induced disorder
F14.99 Cocaine use, unspecified with unspecified cocaine-induced disorder
F15.10 Other stimulant abuse, uncomplicated
F15.11 Other stimulant abuse, in remission
F15.120 Other stimulant abuse with intoxication, uncomplicated
F15.121 Other stimulant abuse with intoxication delirium
F15.122 Other stimulant abuse with intoxication with perceptual disturbance
F15.129 Other stimulant abuse with intoxication, unspecified
F15.13 Other stimulant abuse with withdrawal
F15.14 Other stimulant abuse with stimulant-induced mood disorder
F15.150 Other stimulant abuse with stimulant-induced psychotic disorder with delusions
F15.151 Other stimulant abuse with stimulant-induced psychotic disorder with hallucinations
F15.159 Other stimulant abuse with stimulant-induced psychotic disorder, unspecified
F15.180 Other stimulant abuse with stimulant-induced anxiety disorder
F15.181 Other stimulant abuse with stimulant-induced sexual dysfunction
F15.182 Other stimulant abuse with stimulant-induced sleep disorder
F15.188 Other stimulant abuse with other stimulant-induced disorder
F15.19 Other stimulant abuse with unspecified stimulant-induced disorder
F15.20 Other stimulant dependence, uncomplicated
F15.21 Other stimulant dependence, in remission
F15.220 Other stimulant dependence with intoxication, uncomplicated
F15.221 Other stimulant dependence with intoxication delirium
F15.222 Other stimulant dependence with intoxication with perceptual disturbance
F15.229 Other stimulant dependence with intoxication, unspecified
F15.23 Other stimulant dependence with withdrawal
F15.24 Other stimulant dependence with stimulant-induced mood disorder
F15.250 Other stimulant dependence with stimulant-induced psychotic disorder with delusions
F15.251 Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations
F15.259 Other stimulant dependence with stimulant-induced psychotic disorder, unspecified
F15.280 Other stimulant dependence with stimulant-induced anxiety disorder
F15.281 Other stimulant dependence with stimulant-induced sexual dysfunction
F15.282 Other stimulant dependence with stimulant-induced sleep disorder
F15.288 Other stimulant dependence with other stimulant-induced disorder
F15.29 Other stimulant dependence with unspecified stimulant-induced disorder
F15.90 Other stimulant use, unspecified, uncomplicated
F15.91 Other stimulant use, unspecified, in remission
F15.920 Other stimulant use, unspecified with intoxication, uncomplicated
F15.921 Other stimulant use, unspecified with intoxication delirium
F15.922 Other stimulant use, unspecified with intoxication with perceptual disturbance
F15.929 Other stimulant use, unspecified with intoxication, unspecified
F15.93 Other stimulant use, unspecified with withdrawal
F15.94 Other stimulant use, unspecified with stimulant-induced mood disorder
F15.950 Other stimulant use, unspecified with stimulant-induced psychotic disorder with delusions
F15.951 Other stimulant use, unspecified with stimulant-induced psychotic disorder with hallucinations
F15.959 Other stimulant use, unspecified with stimulant-induced psychotic disorder, unspecified
F15.980 Other stimulant use, unspecified with stimulant-induced anxiety disorder
F15.981 Other stimulant use, unspecified with stimulant-induced sexual dysfunction
F15.982 Other stimulant use, unspecified with stimulant-induced sleep disorder
F15.988 Other stimulant use, unspecified with other stimulant-induced disorder
F15.99 Other stimulant use, unspecified with unspecified stimulant-induced disorder
F16.10 Hallucinogen abuse, uncomplicated
F16.11 Hallucinogen abuse, in remission
F16.120 Hallucinogen abuse with intoxication, uncomplicated
F16.121 Hallucinogen abuse with intoxication with delirium
F16.122 Hallucinogen abuse with intoxication with perceptual disturbance
F16.129 Hallucinogen abuse with intoxication, unspecified
F16.14 Hallucinogen abuse with hallucinogen-induced mood disorder
F16.150 Hallucinogen abuse with hallucinogen-induced psychotic disorder with delusions
F16.151 Hallucinogen abuse with hallucinogen-induced psychotic disorder with hallucinations
F16.159 Hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified
F16.180 Hallucinogen abuse with hallucinogen-induced anxiety disorder
F16.183 Hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks)
F16.188 Hallucinogen abuse with other hallucinogen-induced disorder
F16.19 Hallucinogen abuse with unspecified hallucinogen-induced disorder
F16.20 Hallucinogen dependence, uncomplicated
F16.21 Hallucinogen dependence, in remission
F16.220 Hallucinogen dependence with intoxication, uncomplicated
F16.221 Hallucinogen dependence with intoxication with delirium
F16.229 Hallucinogen dependence with intoxication, unspecified
F16.24 Hallucinogen dependence with hallucinogen-induced mood disorder
F16.250 Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions
F16.251 Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations
F16.259 Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified
F16.280 Hallucinogen dependence with hallucinogen-induced anxiety disorder
F16.283 Hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks)
F16.288 Hallucinogen dependence with other hallucinogen-induced disorder
F16.29 Hallucinogen dependence with unspecified hallucinogen-induced disorder
F16.90 Hallucinogen use, unspecified, uncomplicated
F16.91 Hallucinogen use, unspecified, in remission
F16.920 Hallucinogen use, unspecified with intoxication, uncomplicated
F16.921 Hallucinogen use, unspecified with intoxication with delirium
F16.929 Hallucinogen use, unspecified with intoxication, unspecified
F16.94 Hallucinogen use, unspecified with hallucinogen-induced mood disorder
F16.950 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions
F16.951 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with hallucinations
F16.959 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder, unspecified
F16.980 Hallucinogen use, unspecified with hallucinogen-induced anxiety disorder
F16.983 Hallucinogen use, unspecified with hallucinogen persisting perception disorder (flashbacks)
F16.988 Hallucinogen use, unspecified with other hallucinogen-induced disorder
F16.99 Hallucinogen use, unspecified with unspecified hallucinogen-induced disorder
F18.10 Inhalant abuse, uncomplicated
F18.11 Inhalant abuse, in remission
F18.120 Inhalant abuse with intoxication, uncomplicated
F18.121 Inhalant abuse with intoxication delirium
F18.129 Inhalant abuse with intoxication, unspecified
F18.14 Inhalant abuse with inhalant-induced mood disorder
F18.150 Inhalant abuse with inhalant-induced psychotic disorder with delusions
F18.151 Inhalant abuse with inhalant-induced psychotic disorder with hallucinations
F18.159 Inhalant abuse with inhalant-induced psychotic disorder, unspecified
F18.17 Inhalant abuse with inhalant-induced dementia
F18.180 Inhalant abuse with inhalant-induced anxiety disorder
F18.188 Inhalant abuse with other inhalant-induced disorder
F18.19 Inhalant abuse with unspecified inhalant-induced disorder
F18.20 Inhalant dependence, uncomplicated
F18.21 Inhalant dependence, in remission
F18.220 Inhalant dependence with intoxication, uncomplicated
F18.221 Inhalant dependence with intoxication delirium
F18.229 Inhalant dependence with intoxication, unspecified
F18.24 Inhalant dependence with inhalant-induced mood disorder
F18.250 Inhalant dependence with inhalant-induced psychotic disorder with delusions
F18.251 Inhalant dependence with inhalant-induced psychotic disorder with hallucinations
F18.259 Inhalant dependence with inhalant-induced psychotic disorder, unspecified
F18.27 Inhalant dependence with inhalant-induced dementia
F18.280 Inhalant dependence with inhalant-induced anxiety disorder
F18.288 Inhalant dependence with other inhalant-induced disorder
F18.29 Inhalant dependence with unspecified inhalant-induced disorder
F18.90 Inhalant use, unspecified, uncomplicated
F18.91 Inhalant use, unspecified, in remission
F18.920 Inhalant use, unspecified with intoxication, uncomplicated
F18.921 Inhalant use, unspecified with intoxication with delirium
F18.929 Inhalant use, unspecified with intoxication, unspecified
F18.94 Inhalant use, unspecified with inhalant-induced mood disorder
F18.950 Inhalant use, unspecified with inhalant-induced psychotic disorder with delusions
F18.951 Inhalant use, unspecified with inhalant-induced psychotic disorder with hallucinations
F18.959 Inhalant use, unspecified with inhalant-induced psychotic disorder, unspecified
F18.97 Inhalant use, unspecified with inhalant-induced persisting dementia
F18.980 Inhalant use, unspecified with inhalant-induced anxiety disorder
F18.988 Inhalant use, unspecified with other inhalant-induced disorder
F18.99 Inhalant use, unspecified with unspecified inhalant-induced disorder
F19.10 Other psychoactive substance abuse, uncomplicated
F19.11 Other psychoactive substance abuse, in remission
F19.120 Other psychoactive substance abuse with intoxication, uncomplicated
F19.121 Other psychoactive substance abuse with intoxication delirium
F19.122 Other psychoactive substance abuse with intoxication with perceptual disturbances
F19.129 Other psychoactive substance abuse with intoxication, unspecified
F19.130 Other psychoactive substance abuse with withdrawal, uncomplicated
F19.131 Other psychoactive substance abuse with withdrawal delirium
F19.132 Other psychoactive substance abuse with withdrawal with perceptual disturbance
F19.139 Other psychoactive substance abuse with withdrawal, unspecified
F19.14 Other psychoactive substance abuse with psychoactive substance-induced mood disorder
F19.150 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delusions
F19.151 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with hallucinations
F19.159 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified
F19.16 Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder
F19.17 Other psychoactive substance abuse with psychoactive substance-induced persisting dementia
F19.180 Other psychoactive substance abuse with psychoactive substance-induced anxiety disorder
F19.181 Other psychoactive substance abuse with psychoactive substance-induced sexual dysfunction
F19.182 Other psychoactive substance abuse with psychoactive substance-induced sleep disorder
F19.188 Other psychoactive substance abuse with other psychoactive substance-induced disorder
F19.19 Other psychoactive substance abuse with unspecified psychoactive substance-induced disorder
F19.20 Other psychoactive substance dependence, uncomplicated
F19.21 Other psychoactive substance dependence, in remission
F19.220 Other psychoactive substance dependence with intoxication, uncomplicated
F19.221 Other psychoactive substance dependence with intoxication delirium
F19.222 Other psychoactive substance dependence with intoxication with perceptual disturbance
F19.229 Other psychoactive substance dependence with intoxication, unspecified
F19.230 Other psychoactive substance dependence with withdrawal, uncomplicated
F19.231 Other psychoactive substance dependence with withdrawal delirium
F19.232 Other psychoactive substance dependence with withdrawal with perceptual disturbance
F19.239 Other psychoactive substance dependence with withdrawal, unspecified
F19.24 Other psychoactive substance dependence with psychoactive substance-induced mood disorder
F19.250 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with delusions
F19.251 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations
F19.259 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified
F19.26 Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder
F19.27 Other psychoactive substance dependence with psychoactive substance-induced persisting dementia
F19.280 Other psychoactive substance dependence with psychoactive substance-induced anxiety disorder
F19.281 Other psychoactive substance dependence with psychoactive substance-induced sexual dysfunction
F19.282 Other psychoactive substance dependence with psychoactive substance-induced sleep disorder
F19.288 Other psychoactive substance dependence with other psychoactive substance-induced disorder
F19.29 Other psychoactive substance dependence with unspecified psychoactive substance-induced disorder
F19.90 Other psychoactive substance use, unspecified, uncomplicated
F19.91 Other psychoactive substance use, unspecified, in remission
F19.920 Other psychoactive substance use, unspecified with intoxication, uncomplicated
F19.921 Other psychoactive substance use, unspecified with intoxication with delirium
F19.922 Other psychoactive substance use, unspecified with intoxication with perceptual disturbance
F19.929 Other psychoactive substance use, unspecified with intoxication, unspecified
F19.930 Other psychoactive substance use, unspecified with withdrawal, uncomplicated
F19.931 Other psychoactive substance use, unspecified with withdrawal delirium
F19.932 Other psychoactive substance use, unspecified with withdrawal with perceptual disturbance
F19.939 Other psychoactive substance use, unspecified with withdrawal, unspecified
F19.94 Other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder
F19.950 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions
F19.951 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations
F19.959 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified
F19.96 Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder
F19.97 Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia
F19.980 Other psychoactive substance use, unspecified with psychoactive substance-induced anxiety disorder
F19.981 Other psychoactive substance use, unspecified with psychoactive substance-induced sexual dysfunction
F19.982 Other psychoactive substance use, unspecified with psychoactive substance-induced sleep disorder
F19.988 Other psychoactive substance use, unspecified with other psychoactive substance-induced disorder
F19.99 Other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder
F20.0 Paranoid schizophrenia
F20.1 Disorganized schizophrenia
F20.2 Catatonic schizophrenia
F20.89 Other schizophrenia
F20.9 Schizophrenia, unspecified
F25.0 Schizoaffective disorder, bipolar type
F25.1 Schizoaffective disorder, depressive type
F25.9 Schizoaffective disorder, unspecified
F29 Unspecified psychosis not due to a substance or known physiological condition
F30.10 Manic episode without psychotic symptoms, unspecified
F31.13 Bipolar disorder, current episode manic without psychotic features, severe
F31.30 Bipolar disorder, current episode depressed, mild or moderate severity, unspecified
F31.32 Bipolar disorder, current episode depressed, moderate
F31.4 Bipolar disorder, current episode depressed, severe, without psychotic features
F31.5 Bipolar disorder, current episode depressed, severe, with psychotic features
F31.60 Bipolar disorder, current episode mixed, unspecified
F31.62 Bipolar disorder, current episode mixed, moderate
F31.63 Bipolar disorder, current episode mixed, severe, without psychotic features
F31.70 Bipolar disorder, currently in remission, most recent episode unspecified
F31.81 Bipolar II disorder
F31.9 Bipolar disorder, unspecified
F32.0 Major depressive disorder, single episode, mild
F32.1 Major depressive disorder, single episode, moderate
F32.3 Major depressive disorder, single episode, severe with psychotic features
F32.5 Major depressive disorder, single episode, in full remission
F32.9 Major depressive disorder, single episode, unspecified
F32.A Depression, unspecified
F33.0 Major depressive disorder, recurrent, mild
F33.1 Major depressive disorder, recurrent, moderate
F33.2 Major depressive disorder, recurrent severe without psychotic features
F33.3 Major depressive disorder, recurrent, severe with psychotic symptoms
F33.41 Major depressive disorder, recurrent, in partial remission
F33.42 Major depressive disorder, recurrent, in full remission
F33.8 Other recurrent depressive disorders
F33.9 Major depressive disorder, recurrent, unspecified
F34.1 Dysthymic disorder
F41.0 Panic disorder [episodic paroxysmal anxiety]
F41.1 Generalized anxiety disorder
F41.3 Other mixed anxiety disorders
F41.8 Other specified anxiety disorders
F41.9 Anxiety disorder, unspecified
F45.42 Pain disorder with related psychological factors
F51.01 Primary insomnia
F51.04 Psychophysiologic insomnia
F51.05 Insomnia due to other mental disorder
F55.0 Abuse of antacids
F55.1 Abuse of herbal or folk remedies
F55.2 Abuse of laxatives
F55.3 Abuse of steroids or hormones
F55.4 Abuse of vitamins
F55.8 Abuse of other non-psychoactive substances
F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type
F90.2 Attention-deficit hyperactivity disorder, combined type
F90.9 Attention-deficit hyperactivity disorder, unspecified type
G40.301 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus
G40.309 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus
G40.311 Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus
G40.319 Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus
G40.401 Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus
G40.409 Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus
G40.411 Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus
G40.419 Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus
G40.901 Epilepsy, unspecified, not intractable, with status epilepticus
G40.909 Epilepsy, unspecified, not intractable, without status epilepticus
G40.911 Epilepsy, unspecified, intractable, with status epilepticus
G40.919 Epilepsy, unspecified, intractable, without status epilepticus
G89.29 Other chronic pain
G89.4 Chronic pain syndrome
I44.0 Atrioventricular block, first degree
I44.1 Atrioventricular block, second degree
I44.30 Unspecified atrioventricular block
I45.81 Long QT syndrome
I47.0 Re-entry ventricular arrhythmia
I47.11 Inappropriate sinus tachycardia, so stated
I47.19 Other supraventricular tachycardia
I47.20 Ventricular tachycardia, unspecified
I47.21 Torsades de pointes
I47.29 Other ventricular tachycardia
I49.2 Junctional premature depolarization
M25.50 Pain in unspecified joint
M47.21 Other spondylosis with radiculopathy, occipito-atlanto-axial region
M47.22 Other spondylosis with radiculopathy, cervical region
M47.23 Other spondylosis with radiculopathy, cervicothoracic region
M47.26 Other spondylosis with radiculopathy, lumbar region
M47.27 Other spondylosis with radiculopathy, lumbosacral region
M47.28 Other spondylosis with radiculopathy, sacral and sacrococcygeal region
M47.811 Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region
M47.812 Spondylosis without myelopathy or radiculopathy, cervical region
M47.813 Spondylosis without myelopathy or radiculopathy, cervicothoracic region
M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region
M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region
M47.818 Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region
M47.891 Other spondylosis, occipito-atlanto-axial region
M47.892 Other spondylosis, cervical region
M47.893 Other spondylosis, cervicothoracic region
M47.896 Other spondylosis, lumbar region
M47.897 Other spondylosis, lumbosacral region
M47.898 Other spondylosis, sacral and sacrococcygeal region
M51.14 Intervertebral disc disorders with radiculopathy, thoracic region
M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region
M51.16 Intervertebral disc disorders with radiculopathy, lumbar region
M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region
M51.360 Other intervertebral disc degeneration, lumbar region with discogenic back pain only
M51.361 Other intervertebral disc degeneration, lumbar region with lower extremity pain only
M51.362 Other intervertebral disc degeneration, lumbar region with discogenic back pain and lower extremity pain
M51.369 Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain
M51.370 Other intervertebral disc degeneration, lumbosacral region with discogenic back pain only
M51.371 Other intervertebral disc degeneration, lumbosacral region with lower extremity pain only
M51.372 Other intervertebral disc degeneration, lumbosacral region with discogenic back pain and lower extremity pain
M51.379 Other intervertebral disc degeneration, lumbosacral region without mention of lumbar back pain or lower extremity pain
M54.14 Radiculopathy, thoracic region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region
M54.18 Radiculopathy, sacral and sacrococcygeal region
M54.2 Cervicalgia
M54.51 Vertebrogenic low back pain
M54.9 Dorsalgia, unspecified
M60.811 Other myositis, right shoulder
M60.812 Other myositis, left shoulder
M60.821 Other myositis, right upper arm
M60.822 Other myositis, left upper arm
M60.831 Other myositis, right forearm
M60.832 Other myositis, left forearm
M60.841 Other myositis, right hand
M60.842 Other myositis, left hand
M60.851 Other myositis, right thigh
M60.852 Other myositis, left thigh
M60.861 Other myositis, right lower leg
M60.862 Other myositis, left lower leg
M60.871 Other myositis, right ankle and foot
M60.872 Other myositis, left ankle and foot
M60.88 Other myositis, other site
M60.89 Other myositis, multiple sites
M60.9 Myositis, unspecified
M79.10 Myalgia, unspecified site
M79.11 Myalgia of mastication muscle
M79.12 Myalgia of auxiliary muscles, head and neck
M79.18 Myalgia, other site
M79.2 Neuralgia and neuritis, unspecified
M79.7 Fibromyalgia
R40.0 Somnolence
R40.1 Stupor
R40.20 Unspecified coma
R40.2110 Coma scale, eyes open, never, unspecified time
R40.2111 Coma scale, eyes open, never, in the field [EMT or ambulance]
R40.2112 Coma scale, eyes open, never, at arrival to emergency department
R40.2113 Coma scale, eyes open, never, at hospital admission
R40.2114 Coma scale, eyes open, never, 24 hours or more after hospital admission
R40.2120 Coma scale, eyes open, to pain, unspecified time
R40.2121 Coma scale, eyes open, to pain, in the field [EMT or ambulance]
R40.2122 Coma scale, eyes open, to pain, at arrival to emergency department
R40.2123 Coma scale, eyes open, to pain, at hospital admission
R40.2124 Coma scale, eyes open, to pain, 24 hours or more after hospital admission
R40.2210 Coma scale, best verbal response, none, unspecified time
R40.2211 Coma scale, best verbal response, none, in the field [EMT or ambulance]
R40.2212 Coma scale, best verbal response, none, at arrival to emergency department
R40.2213 Coma scale, best verbal response, none, at hospital admission
R40.2214 Coma scale, best verbal response, none, 24 hours or more after hospital admission
R40.2220 Coma scale, best verbal response, incomprehensible words, unspecified time
R40.2221 Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance]
R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department
R40.2223 Coma scale, best verbal response, incomprehensible words, at hospital admission
R40.2224 Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
R40.2310 Coma scale, best motor response, none, unspecified time
R40.2311 Coma scale, best motor response, none, in the field [EMT or ambulance]
R40.2312 Coma scale, best motor response, none, at arrival to emergency department
R40.2313 Coma scale, best motor response, none, at hospital admission
R40.2314 Coma scale, best motor response, none, 24 hours or more after hospital admission
R40.2320 Coma scale, best motor response, extension, unspecified time
R40.2321 Coma scale, best motor response, extension, in the field [EMT or ambulance]
R40.2322 Coma scale, best motor response, extension, at arrival to emergency department
R40.2323 Coma scale, best motor response, extension, at hospital admission
R40.2324 Coma scale, best motor response, extension, 24 hours or more after hospital admission
R40.2340 Coma scale, best motor response, flexion withdrawal, unspecified time
R40.2341 Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance]
R40.2342 Coma scale, best motor response, flexion withdrawal, at arrival to emergency department
R40.2343 Coma scale, best motor response, flexion withdrawal, at hospital admission
R40.2344 Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
R40.2A Nontraumatic coma due to underlying condition
R44.0 Auditory hallucinations
R44.2 Other hallucinations
R56.9 Unspecified convulsions
T14.91XA Suicide attempt, initial encounter
T14.91XD Suicide attempt, subsequent encounter
T14.91XS Suicide attempt, sequela
T39.011A Poisoning by aspirin, accidental (unintentional), initial encounter
T39.012A Poisoning by aspirin, intentional self-harm, initial encounter
T39.013A Poisoning by aspirin, assault, initial encounter
T39.014A Poisoning by aspirin, undetermined, initial encounter
T39.091A Poisoning by salicylates, accidental (unintentional), initial encounter
T39.092A Poisoning by salicylates, intentional self-harm, initial encounter
T39.093A Poisoning by salicylates, assault, initial encounter
T39.094A Poisoning by salicylates, undetermined, initial encounter
T39.1X1A Poisoning by 4-Aminophenol derivatives, accidental (unintentional), initial encounter
T39.1X2A Poisoning by 4-Aminophenol derivatives, intentional self-harm, initial encounter
T39.1X3A Poisoning by 4-Aminophenol derivatives, assault, initial encounter
T39.1X4A Poisoning by 4-Aminophenol derivatives, undetermined, initial encounter
T39.2X1A Poisoning by pyrazolone derivatives, accidental (unintentional), initial encounter
T39.2X2A Poisoning by pyrazolone derivatives, intentional self-harm, initial encounter
T39.2X3A Poisoning by pyrazolone derivatives, assault, initial encounter
T39.2X4A Poisoning by pyrazolone derivatives, undetermined, initial encounter
T39.311A Poisoning by propionic acid derivatives, accidental (unintentional), initial encounter
T39.312A Poisoning by propionic acid derivatives, intentional self-harm, initial encounter
T39.313A Poisoning by propionic acid derivatives, assault, initial encounter
T39.314A Poisoning by propionic acid derivatives, undetermined, initial encounter
T39.391A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], accidental (unintentional), initial encounter
T39.392A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], intentional self-harm, initial encounter
T39.393A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], assault, initial encounter
T39.394A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], undetermined, initial encounter
T40.0X1A Poisoning by opium, accidental (unintentional), initial encounter
T40.0X2A Poisoning by opium, intentional self-harm, initial encounter
T40.0X3A Poisoning by opium, assault, initial encounter
T40.0X4A Poisoning by opium, undetermined, initial encounter
T40.1X1A Poisoning by heroin, accidental (unintentional), initial encounter
T40.1X2A Poisoning by heroin, intentional self-harm, initial encounter
T40.1X3A Poisoning by heroin, assault, initial encounter
T40.1X4A Poisoning by heroin, undetermined, initial encounter
T40.2X1A Poisoning by other opioids, accidental (unintentional), initial encounter
T40.2X2A Poisoning by other opioids, intentional self-harm, initial encounter
T40.2X3A Poisoning by other opioids, assault, initial encounter
T40.2X4A Poisoning by other opioids, undetermined, initial encounter
T40.3X1A Poisoning by methadone, accidental (unintentional), initial encounter
T40.3X2A Poisoning by methadone, intentional self-harm, initial encounter
T40.3X3A Poisoning by methadone, assault, initial encounter
T40.3X4A Poisoning by methadone, undetermined, initial encounter
T40.491A Poisoning by other synthetic narcotics, accidental (unintentional), initial encounter
T40.491D Poisoning by other synthetic narcotics, accidental (unintentional), subsequent encounter
T40.491S Poisoning by other synthetic narcotics, accidental (unintentional), sequela
T40.492A Poisoning by other synthetic narcotics, intentional self-harm, initial encounter
T40.492D Poisoning by other synthetic narcotics, intentional self-harm, subsequent encounter
T40.492S Poisoning by other synthetic narcotics, intentional self-harm, sequela
T40.493A Poisoning by other synthetic narcotics, assault, initial encounter
T40.493D Poisoning by other synthetic narcotics, assault, subsequent encounter
T40.493S Poisoning by other synthetic narcotics, assault, sequela
T40.494A Poisoning by other synthetic narcotics, undetermined, initial encounter
T40.494D Poisoning by other synthetic narcotics, undetermined, subsequent encounter
T40.494S Poisoning by other synthetic narcotics, undetermined, sequela
T40.601A Poisoning by unspecified narcotics, accidental (unintentional), initial encounter
T40.602A Poisoning by unspecified narcotics, intentional self-harm, initial encounter
T40.603A Poisoning by unspecified narcotics, assault, initial encounter
T40.604A Poisoning by unspecified narcotics, undetermined, initial encounter
T40.691A Poisoning by other narcotics, accidental (unintentional), initial encounter
T40.692A Poisoning by other narcotics, intentional self-harm, initial encounter
T40.693A Poisoning by other narcotics, assault, initial encounter
T40.694A Poisoning by other narcotics, undetermined, initial encounter
T40.711A Poisoning by cannabis, accidental (unintentional), initial encounter
T40.711D Poisoning by cannabis, accidental (unintentional), subsequent encounter
T40.711S Poisoning by cannabis, accidental (unintentional), sequela
T40.712A Poisoning by cannabis, intentional self-harm, initial encounter
T40.712D Poisoning by cannabis, intentional self-harm, subsequent encounter
T40.712S Poisoning by cannabis, intentional self-harm, sequela
T40.713A Poisoning by cannabis, assault, initial encounter
T40.713D Poisoning by cannabis, assault, subsequent encounter
T40.713S Poisoning by cannabis, assault, sequela
T40.714A Poisoning by cannabis, undetermined, initial encounter
T40.714D Poisoning by cannabis, undetermined, subsequent encounter
T40.714S Poisoning by cannabis, undetermined, sequela
T40.8X1A Poisoning by lysergide [LSD], accidental (unintentional), initial encounter
T40.8X2A Poisoning by lysergide [LSD], intentional self-harm, initial encounter
T40.8X3A Poisoning by lysergide [LSD], assault, initial encounter
T40.8X4A Poisoning by lysergide [LSD], undetermined, initial encounter
T40.901A Poisoning by unspecified psychodysleptics [hallucinogens], accidental (unintentional), initial encounter
T40.902A Poisoning by unspecified psychodysleptics [hallucinogens], intentional self-harm, initial encounter
T40.903A Poisoning by unspecified psychodysleptics [hallucinogens], assault, initial encounter
T40.904A Poisoning by unspecified psychodysleptics [hallucinogens], undetermined, initial encounter
T40.991A Poisoning by other psychodysleptics [hallucinogens], accidental (unintentional), initial encounter
T40.992A Poisoning by other psychodysleptics [hallucinogens], intentional self-harm, initial encounter
T40.993A Poisoning by other psychodysleptics [hallucinogens], assault, initial encounter
T40.994A Poisoning by other psychodysleptics [hallucinogens], undetermined, initial encounter
T42.0X1A Poisoning by hydantoin derivatives, accidental (unintentional), initial encounter
T42.0X2A Poisoning by hydantoin derivatives, intentional self-harm, initial encounter
T42.0X3A Poisoning by hydantoin derivatives, assault, initial encounter
T42.0X4A Poisoning by hydantoin derivatives, undetermined, initial encounter
T42.3X1A Poisoning by barbiturates, accidental (unintentional), initial encounter
T42.3X2A Poisoning by barbiturates, intentional self-harm, initial encounter
T42.3X3A Poisoning by barbiturates, assault, initial encounter
T42.3X4A Poisoning by barbiturates, undetermined, initial encounter
T42.4X1A Poisoning by benzodiazepines, accidental (unintentional), initial encounter
T42.4X2A Poisoning by benzodiazepines, intentional self-harm, initial encounter
T42.4X3A Poisoning by benzodiazepines, assault, initial encounter
T42.4X4A Poisoning by benzodiazepines, undetermined, initial encounter
T42.6X1A Poisoning by other antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial encounter
T42.6X2A Poisoning by other antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter
T42.6X3A Poisoning by other antiepileptic and sedative-hypnotic drugs, assault, initial encounter
T42.6X4A Poisoning by other antiepileptic and sedative-hypnotic drugs, undetermined, initial encounter
T42.71XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial encounter
T42.72XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter
T42.73XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, assault, initial encounter
T42.74XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, undetermined, initial encounter
T43.011A Poisoning by tricyclic antidepressants, accidental (unintentional), initial encounter
T43.012A Poisoning by tricyclic antidepressants, intentional self-harm, initial encounter
T43.013A Poisoning by tricyclic antidepressants, assault, initial encounter
T43.014A Poisoning by tricyclic antidepressants, undetermined, initial encounter
T43.021A Poisoning by tetracyclic antidepressants, accidental (unintentional), initial encounter
T43.022A Poisoning by tetracyclic antidepressants, intentional self-harm, initial encounter
T43.023A Poisoning by tetracyclic antidepressants, assault, initial encounter
T43.024A Poisoning by tetracyclic antidepressants, undetermined, initial encounter
T43.1X1A Poisoning by monoamine-oxidase-inhibitor antidepressants, accidental (unintentional), initial encounter
T43.1X2A Poisoning by monoamine-oxidase-inhibitor antidepressants, intentional self-harm, initial encounter
T43.1X3A Poisoning by monoamine-oxidase-inhibitor antidepressants, assault, initial encounter
T43.1X4A Poisoning by monoamine-oxidase-inhibitor antidepressants, undetermined, initial encounter
T43.201A Poisoning by unspecified antidepressants, accidental (unintentional), initial encounter
T43.202A Poisoning by unspecified antidepressants, intentional self-harm, initial encounter
T43.203A Poisoning by unspecified antidepressants, assault, initial encounter
T43.204A Poisoning by unspecified antidepressants, undetermined, initial encounter
T43.211A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, accidental (unintentional), initial encounter
T43.212A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, intentional self-harm, initial encounter
T43.213A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, assault, initial encounter
T43.214A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, undetermined, initial encounter
T43.221A Poisoning by selective serotonin reuptake inhibitors, accidental (unintentional), initial encounter
T43.222A Poisoning by selective serotonin reuptake inhibitors, intentional self-harm, initial encounter
T43.223A Poisoning by selective serotonin reuptake inhibitors, assault, initial encounter
T43.224A Poisoning by selective serotonin reuptake inhibitors, undetermined, initial encounter
T43.291A Poisoning by other antidepressants, accidental (unintentional), initial encounter
T43.292A Poisoning by other antidepressants, intentional self-harm, initial encounter
T43.293A Poisoning by other antidepressants, assault, initial encounter
T43.294A Poisoning by other antidepressants, undetermined, initial encounter
T43.3X1A Poisoning by phenothiazine antipsychotics and neuroleptics, accidental (unintentional), initial encounter
T43.3X2A Poisoning by phenothiazine antipsychotics and neuroleptics, intentional self-harm, initial encounter
T43.3X3A Poisoning by phenothiazine antipsychotics and neuroleptics, assault, initial encounter
T43.3X4A Poisoning by phenothiazine antipsychotics and neuroleptics, undetermined, initial encounter
T43.4X1A Poisoning by butyrophenone and thiothixene neuroleptics, accidental (unintentional), initial encounter
T43.4X2A Poisoning by butyrophenone and thiothixene neuroleptics, intentional self-harm, initial encounter
T43.4X3A Poisoning by butyrophenone and thiothixene neuroleptics, assault, initial encounter
T43.4X4A Poisoning by butyrophenone and thiothixene neuroleptics, undetermined, initial encounter
T43.501A Poisoning by unspecified antipsychotics and neuroleptics, accidental (unintentional), initial encounter
T43.502A Poisoning by unspecified antipsychotics and neuroleptics, intentional self-harm, initial encounter
T43.503A Poisoning by unspecified antipsychotics and neuroleptics, assault, initial encounter
T43.504A Poisoning by unspecified antipsychotics and neuroleptics, undetermined, initial encounter
T43.591A Poisoning by other antipsychotics and neuroleptics, accidental (unintentional), initial encounter
T43.592A Poisoning by other antipsychotics and neuroleptics, intentional self-harm, initial encounter
T43.593A Poisoning by other antipsychotics and neuroleptics, assault, initial encounter
T43.594A Poisoning by other antipsychotics and neuroleptics, undetermined, initial encounter
T43.601A Poisoning by unspecified psychostimulants, accidental (unintentional), initial encounter
T43.602A Poisoning by unspecified psychostimulants, intentional self-harm, initial encounter
T43.603A Poisoning by unspecified psychostimulants, assault, initial encounter
T43.604A Poisoning by unspecified psychostimulants, undetermined, initial encounter
T43.611A Poisoning by caffeine, accidental (unintentional), initial encounter
T43.612A Poisoning by caffeine, intentional self-harm, initial encounter
T43.613A Poisoning by caffeine, assault, initial encounter
T43.614A Poisoning by caffeine, undetermined, initial encounter
T43.621A Poisoning by amphetamines, accidental (unintentional), initial encounter
T43.622A Poisoning by amphetamines, intentional self-harm, initial encounter
T43.623A Poisoning by amphetamines, assault, initial encounter
T43.624A Poisoning by amphetamines, undetermined, initial encounter
T43.631A Poisoning by methylphenidate, accidental (unintentional), initial encounter
T43.632A Poisoning by methylphenidate, intentional self-harm, initial encounter
T43.633A Poisoning by methylphenidate, assault, initial encounter
T43.634A Poisoning by methylphenidate, undetermined, initial encounter
T43.641A Poisoning by ecstasy, accidental (unintentional), initial encounter
T43.641D Poisoning by ecstasy, accidental (unintentional), subsequent encounter
T43.641S Poisoning by ecstasy, accidental (unintentional), sequela
T43.642A Poisoning by ecstasy, intentional self-harm, initial encounter
T43.642D Poisoning by ecstasy, intentional self-harm, subsequent encounter
T43.642S Poisoning by ecstasy, intentional self-harm, sequela
T43.643A Poisoning by ecstasy, assault, initial encounter
T43.643D Poisoning by ecstasy, assault, subsequent encounter
T43.643S Poisoning by ecstasy, assault, sequela
T43.644A Poisoning by ecstasy, undetermined, initial encounter
T43.644D Poisoning by ecstasy, undetermined, subsequent encounter
T43.644S Poisoning by ecstasy, undetermined, sequela
T43.691A Poisoning by other psychostimulants, accidental (unintentional), initial encounter
T43.692A Poisoning by other psychostimulants, intentional self-harm, initial encounter
T43.693A Poisoning by other psychostimulants, assault, initial encounter
T43.694A Poisoning by other psychostimulants, undetermined, initial encounter
T43.8X1A Poisoning by other psychotropic drugs, accidental (unintentional), initial encounter
T43.8X2A Poisoning by other psychotropic drugs, intentional self-harm, initial encounter
T43.8X3A Poisoning by other psychotropic drugs, assault, initial encounter
T43.8X4A Poisoning by other psychotropic drugs, undetermined, initial encounter
T43.91XA Poisoning by unspecified psychotropic drug, accidental (unintentional), initial encounter
T43.92XA Poisoning by unspecified psychotropic drug, intentional self-harm, initial encounter
T43.93XA Poisoning by unspecified psychotropic drug, assault, initial encounter
T43.94XA Poisoning by unspecified psychotropic drug, undetermined, initial encounter
T45.0X1A Poisoning by antiallergic and antiemetic drugs, accidental (unintentional), initial encounter
T45.0X2A Poisoning by antiallergic and antiemetic drugs, intentional self-harm, initial encounter
T45.0X3A Poisoning by antiallergic and antiemetic drugs, assault, initial encounter
T45.0X4A Poisoning by antiallergic and antiemetic drugs, undetermined, initial encounter
T46.0X1A Poisoning by cardiac-stimulant glycosides and drugs of similar action, accidental (unintentional), initial encounter
T46.0X2A Poisoning by cardiac-stimulant glycosides and drugs of similar action, intentional self-harm, initial encounter
T46.0X3A Poisoning by cardiac-stimulant glycosides and drugs of similar action, assault, initial encounter
T46.0X4A Poisoning by cardiac-stimulant glycosides and drugs of similar action, undetermined, initial encounter
T50.901A Poisoning by unspecified drugs, medicaments and biological substances, accidental (unintentional), initial encounter
T50.902A Poisoning by unspecified drugs, medicaments and biological substances, intentional self-harm, initial encounter
T50.903A Poisoning by unspecified drugs, medicaments and biological substances, assault, initial encounter
T50.904A Poisoning by unspecified drugs, medicaments and biological substances, undetermined, initial encounter
T50.911A Poisoning by multiple unspecified drugs, medicaments and biological substances, accidental (unintentional), initial encounter
T50.912A Poisoning by multiple unspecified drugs, medicaments and biological substances, intentional self-harm, initial encounter
T50.913A Poisoning by multiple unspecified drugs, medicaments and biological substances, assault, initial encounter
T50.914A Poisoning by multiple unspecified drugs, medicaments and biological substances, undetermined, initial encounter
T50.915A Adverse effect of multiple unspecified drugs, medicaments and biological substances, initial encounter
T50.915D Adverse effect of multiple unspecified drugs, medicaments and biological substances, subsequent encounter
T50.915S Adverse effect of multiple unspecified drugs, medicaments and biological substances, sequela
T50.916A Underdosing of multiple unspecified drugs, medicaments and biological substances, initial encounter
T50.916D Underdosing of multiple unspecified drugs, medicaments and biological substances, subsequent encounter
T50.916S Underdosing of multiple unspecified drugs, medicaments and biological substances, sequela
Z51.81 Encounter for therapeutic drug level monitoring
Z79.3 Long term (current) use of hormonal contraceptives
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
Z91.120 Patient's intentional underdosing of medication regimen due to financial hardship
Z91.128 Patient's intentional underdosing of medication regimen for other reason
Z91.130 Patient's unintentional underdosing of medication regimen due to age-related debility
Z91.138 Patient's unintentional underdosing of medication regimen for other reason
Z91.141 Patient's other noncompliance with medication regimen due to financial hardship
Z91.148 Patient's other noncompliance with medication regimen for other reason
Z91.190 Patient's noncompliance with other medical treatment and regimen due to financial hardship
Z91.198 Patient's noncompliance with other medical treatment and regimen for other reason
Z91.199 Patient's noncompliance with other medical treatment and regimen due to unspecified reason
Z91.A10 Caregiver's noncompliance with patient's dietary regimen due to financial hardship
Z91.A18 Caregiver's noncompliance with patient's dietary regimen for other reason
Z91.A20 Caregiver's intentional underdosing of patient's medication regimen due to financial hardship
Z91.A28 Caregiver's intentional underdosing of medication regimen for other reason
Z91.A3 Caregiver's unintentional underdosing of patient's medication regimen
Z91.A41 Caregiver's other noncompliance with patient's medication regimen due to financial hardship
Z91.A48 Caregiver's other noncompliance with patient's medication regimen for other reason
Z91.A51 Caregiver's noncompliance with patient's renal dialysis due to financial hardship
Z91.A58 Caregiver's noncompliance with patient's renal dialysis for other reason
Z91.A91 Caregiver's noncompliance with patient's other medical treatment and regimen due to financial hardship
Z91.A98 Caregiver's noncompliance with patient's other medical treatment and regimen for other reason
Z91.51 Personal history of suicidal behavior
Z91.52 Personal history of nonsuicidal self-harm
N/A

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

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

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

Please accept the License to see the codes.

N/A

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.

Code Description

Please accept the License to see the codes.

N/A

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
N/A
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
03/05/2026 R31

Revision Effective: 03/05/2026

Revision Explanation: Annual review, no changes.

08/28/2025 R30

Revision Effective: 08/28/2025 retro effective to 07/24/2025

Revision Explanation: Added M54.51 back to group1 ICD-10 codes as it was removed in error. Also, in revision history Section for #29 Z91.141 should have been Z91.141.

07/24/2025 R29

Revision Effective: 07/24/2025

Revision Explanation: The ICD-10 codes added in revision 28 were added in error and are being removed except for codes Z91.120, Z91.128, Z91.130, Z91.138, Z91.140, Z91.148, Z91.51, and Z91.52. The following codes are being added to group 1 ICD-10 codes that support medical necessity and are retro effective 01/01/2025:

F11.10
F11.120
F11.121
F11.122
F11.129
F11.13
F11.14
F11.150
F11.151
F11.159
F11.181
F11.182
F11.188
F11.19
F11.21
F11.24
F11.90
F11.91
F11.920
F11.921
F11.922
F11.929
F11.93
F11.94
F11.950
F11.951
F11.959
F11.981
F11.982
F11.988
F11.99
F12.10
F12.120
F12.121
F12.122
F12.129
F12.13
F12.150
F12.151
F12.159
F12.180
F12.188
F12.19
F12.20
F12.21
F12.220
F12.221
F12.222
F12.229
F12.23
F12.250
F12.251
F12.259
F12.280
F12.288
F12.29
F12.90
F12.91
F12.920
F12.921
F12.922
F12.929
F12.93
F12.950
F12.951
F12.959
F12.980
F12.988
F12.99
F13.10
F13.120
F13.121
F13.129
F13.130
F13.131
F13.132
F13.139
F13.14
F13.150
F13.151
F13.159
F13.180
F13.181
F13.182
F13.188
F13.19
F13.20
F13.21
F13.220
F13.221
F13.229
F13.230
F13.231
F13.232
F13.239
F13.24
F13.250
F13.251
F13.259
F13.26
F13.27
F13.280
F13.281
F13.282
F13.288
F13.29
F13.90
F13.91
F13.920
F13.921
F13.929
F13.930
F13.931
F13.932
F13.939
F13.94
F13.950
F13.951
F13.959
F13.96
F13.97
F13.980
F13.981
F13.982
F13.988
F13.99
F14.10
F14.120
F14.121
F14.122
F14.129
F14.13
F14.14
F14.150
F14.151
F14.159
F14.180
F14.181
F14.182
F14.188
F14.19
F14.20
F14.21
F14.220
F14.221
F14.222
F14.229
F14.23
F14.24
F14.250
F14.251
F14.259
F14.280
F14.281
F14.282
F14.288
F14.29
F14.90
F14.91
F14.920
F14.921
F14.922
F14.929
F14.93
F14.94
F14.950
F14.951
F14.959
F14.980
F14.981
F14.982
F14.988
F14.99
F15.10
F15.120
F15.121
F15.122
F15.129
F15.13
F15.14
F15.150
F15.151
F15.159
F15.180
F15.181
F15.182
F15.188
F15.19
F15.20
F15.21
F15.220
F15.221
F15.222
F15.229
F15.23
F15.24
F15.250
F15.251
F15.259
F15.280
F15.281
F15.282
F15.288
F15.29
F15.90
F15.91
F15.920
F15.921
F15.922
F15.929
F15.93
F15.94
F15.950
F15.951
F15.959
F15.980
F15.981
F15.982
F15.988
F15.99
F16.10
F16.120
F16.121
F16.122
F16.129
F16.14
F16.150
F16.151
F16.159
F16.180
F16.183
F16.188
F16.19
F16.20
F16.21
F16.220
F16.221
F16.229
F16.24
F16.250
F16.251
F16.259
F16.280
F16.283
F16.288
F16.29
F16.90
F16.91
F16.920
F16.921
F16.929
F16.94
F16.950
F16.951
F16.959
F16.980
F16.983
F16.988
F16.99
F18.121
F18.129
F18.14
F18.150
F18.151
F18.159
F18.17
F18.180
F18.188
F18.19
F18.20
F18.21
F18.220
F18.221
F18.229
F18.24
F18.250
F18.251
F18.259
F18.27
F18.280
F18.288
F18.29
F18.91
F18.920
F18.921
F18.929
F18.94
F18.950
F18.951
F18.959
F18.97
F18.980
F18.988
F18.99
F19.10
F19.11
F19.120
F19.121
F19.122
F19.129
F19.130
F19.131
F19.132
F19.139
F19.14
F19.150
F19.151
F19.159
F19.16
F19.17
F19.180
F19.181
F19.182
F19.188
F19.19
F19.21
F19.220
F19.221
F19.222
F19.229
F19.230
F19.231
F19.232
F19.239
F19.24
F19.250
F19.251
F19.259
F19.26
F19.27
F19.280
F19.281
F19.282
F19.288
F19.29
F19.90
F19.91
F19.920
F19.921
F19.922
F19.929
F19.930
F19.931
F19.932
F19.939
F19.94
F19.950
F19.951
F19.959
F19.96
F19.97
F19.980
F19.981
F19.982
F19.988
F19.99
F20.9
F25.0
F25.1
F25.9
F29.
F30.10
F31.13
F31.30
F31.32
F31.4
F31.5
F31.60
F31.62
F31.63
F31.70
F31.81
F31.9
F32.0
F32.1
F32.3
F32.5
F32.9
F32.A
F33.0
F33.1
F33.2
F33.3
F33.41
F33.42
F33.8
F33.9
F34.1
F41.0
F41.1
F41.3
F41.8
F41.9
F45.42
F51.01
F51.04
F51.05
F90.0
F90.2
F90.9

07/17/2025 R28

Revision Effective: 05/29/2025

Revision Explanation: The following ICD-10 codes are being added to group 1 ICD-10 codes that support medical necessity and are retro effective to 01/01/2025:

F10.10
F10.120
F10.121
F10.129
F10.130
F10.131
F10.132
F10.139
F10.14
F10.150
F10.151
F10.159
F10.180
F10.181
F10.182
F10.188
F10.19
F10.21
F10.220
F10.221
F10.229
F10.230
F10.231
F10.232
F10.239
F10.24
F10.250
F10.251
F10.259
F10.26
F10.27
F10.280
F10.281
F10.282
F10.288
F10.29
F10.90
F10.91
F10.920
F10.921
F10.929
F10.930
F10.931
F10.932
F10.939
F10.94
F10.950
F10.951
F10.959
F10.96
F10.97
F10.980
F10.981
F10.982
F10.988
F10.99

G24.01
G25.1
G25.4
G25.61
G25.70
G25.71
G25.79
G89.11
G89.18
G89.28
G89.3
G90.50
G90.511
G90.529
G90.59
M54.50
M54.59
M54.6
O99.320
O99.321
O99.322
O99.323
O99.324
O99.325
R45.850
R45.851
T50.905D
Z63.72
Z71.41
Z71.42
Z71.51
Z71.52
Z76.0
Z81.1
Z81.3
Z81.4
Z91.120
Z91.128
Z91.130
Z91.138
Z91.141
Z91.148
Z91.51
Z91.52

 

05/29/2025 R27

Revision Effective: 05/29/2025

Revision Explanation: Added ICD-10 codes F15.10 and F15.20 to group 1 ICD-10 codes.

03/06/2025 R26

Revision Effective: 03/06/2025

Revision Explanation: Annual review, no changes.

10/01/2024 R25

Revision Effective: 10/01/0024

Revision Explanation: Codes M51.36 and M51.37 were deleted during the annual ICD-10 update and replaced with the following codes in group 1:

M51.360
M51.361
M51.362
M51.369
M51.370
M51.371
M51.372
M51.379

03/07/2024 R24

Revision Effective: 03/07/2024

Revision Explanation: Annual review, no changes.

11/16/2023 R23

Revision Effective: 11/16/2023

Revisin Explanation: Updated LCD Reference Article section.

10/15/2023 R22

Revision Effective: 10/01/2023
Revision Explanation: Annual ICD-10 update. Added the following: R40.2A.

10/15/2023 R21

Revision Effective: 10/01/2023 
Revision Explanation: Annual ICD-10 update, Deleted the following codes from Group 1: I47.1, Z91.A4 Z91.A5 Z91.A9. Added the following codes to Group 1: I47.11, I47.19, Z91.A41, Z91.A48, Z91.A51, Z91.A58, Z91.A91, and Z91.A98.

10/15/2023 R20

Revision Effective: 10/15/2023
Revision Explanation: Release to final after open comment. Group 2 incorporated into group 1 HCPCS list. Added the following dx: F10.11, F10.20, F11.11, F11.220, F11.221, F11.222, F11.229, F11.250, F11.251, F11.259, F11.281, F11.282, F11.288, F11.29, F12.11, F14.11, F15.11, F16.11, F18.11, F55.0, F55.1, F55.2, F55.4, G40.301, G40.309, G40.311, G40.319, G40.401, G40.409, G40.411, G40.419, G40.901, G40.909, G40.911, G40.919, G89.29, G89.4, I44.0, I44.1, I44.30, I47.0, I47.1, I49.2, M25.50, M47.21, M47.22, M47.23, M47.26, M47.27, M47.28, M47.811, M47.812, M47.813, M47.816, M47.817, M47.818, M47.891, M47.892, M47.893, M47.896, M47.897, M47.898, M51.14, M51.15, M51.16, M51.17, M51.36, M51.37, M54.14, M54.15, M54.16, M54.17, M54.18, M54.2, M54.51, M54.9, M60.811, M60.812, M60.821, M60.822, M60.831, M60.832, M60.841, M60.842, M60.851, M60.852, M60.861, M60.862, M60.871, M60.872, M60.88, M60.89, M60.9, M79.10, M79.11, M79.12, M79.18, M79.2, M79.7, R40.20, T14.91XA, T14.91XD, T14.91XS, T50.915A, T50.915D, T50.915S, T50.916A, T50.916D, T50.916S, Z51.81, Z79.3, Z91.199, Z91.A10, Z91.A18, Z91.A20, Z91.A28, Z91.A3, Z91.A4, Z91.A5, Z91.A9. Removed the following dx: F11.13, F12.13, F12.23, F12.93, F13.130, F13.131, F13.132, F14.13, F14.91, F14.93, F15.13, F18.91, F19.130, F19.131, F19.132, R41.0, R41.82, T40.411A, T40.411D, T40.411S,T40.412A, T40.412D, T40.412S, T40.413A, T40.413D, T40.413S, T40.414A, T40.414D, T40.414S, T40.421A, T40.421D, T40.421S, T40.422A, T40.422D, T40.422S, T40.423A, T40.423D, T40.423S, T40.424A, T40.424D, T40.424S, T40.5X1A, T40.5X1D, T40.5X1S, T40.5X2A, T40.5X2D, T40.5X2S, T40.5X3A, T40.5X3D, T40.5X3S, T40.5X4A, T40.5X4D, T40.5X4S, T40.721A, T40.721D, T40.721S, T40.722A, T40.722D, T40.722S, T40.723A, T40.723D, T40.723S, T40.724A, T40.724D, T40.724S, T43.651A, T43.651D, T43.651S, T43.652A, T43.652D, T43.652S, T43.653A, T43.653D, T43.653S, T43.654A, T43.654D, T43.654S, T43.655A, T43.655D, T43.655S, Z03.89, Z91.120, Z91.128, Z91.130, Z91.138, Z91.14

03/09/2023 R19

Revision Effective: 03/03/2023
Revision Explanation: Annual review, no changes 

10/01/2022 R18

Revision Effective: 10/01/2022
Revision Explanation: Correction to R17-The revision effective date is 10/01/2022. Annual ICD-10 Update, Removed E87.2, I47.2, Z91.19 and added E87.21, E87.22, E87.29, I47.21, I47.29, Z91.190, Z91.198, and Z91.199 

10/01/2022 R17

R17

Revision Effective: 09/19/2022
Revision Explanation: Annual ICD-10 Update, added F12.91, F14.91, F18.91, T43.651A, T43.651D, T43.651S, T43.652A, T43.652D, T43.652S, T43.653A, T43.653D, T43.653S
T43.654A, T43.654D, T43.654S, T43.655A, T43.655D, T43.655S, T43.656A, T43.656D, T43.656S, Z03.83, and Z79.85

 

02/10/2022 R16

R16

Revision Effective: 02/10/2022
Revision Explanation: Annual review, no changes were made.

10/01/2021 R15

R15

Revision Effective: 10/01/2021
Revision Explanation: ICD-10 codes M79.10-M79.12 were removed inn error during annual ICD-10 update and have been added back.

10/01/2021 R14

R14
Revision Effective: 10/01/2021
Revision Explanation: Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted M54.5,T40.7X1A,T40.7X2A, T40.7X3A, T40.7X4A and added T40.711A, T40.711D, T40.711S, T40.712A, T40.712D, T40.712S, T40.713A, T40.713D, T40.713S, T40.714A, T40.714D, T40.714S, T40.721A, T40.721D, T40.721S, T40.722A, T40.722D, T40.722S, T40.723A, T40.723D, T40.723S, T40.724A, T40.724D, T40.724S. This revision is due to the Annual ICD-10 update and is effective on 10/1/21.

10/01/2021 R13

R13
Revision Effective: 10/01/2021
Revision Explanation: Annual ICD-10 update. Under ICD-10-CM Codes that Support Medical Necessity Group 1: Code added R45.88.

06/17/2021 R12

R12
Revision Effective: 06/17/2021
Revision Explanation: Annual review, no changes were made.

04/15/2021 R11

R11
Revision Effective: 03/08/2021
Revision Explanation: In revisions 5 and 7  ICD-10 codes F10.139, F13.139, and F19.139 were listed as being added under these revisons in error. These codes were actually being removed as there are more appropriate codes available.  Codes G40.901, G40.909, G40.911 and G40.919 were removed during these revisions but were not listed in the revision explanation. These unspecified codes were removed as there are more appropriate codes available.

04/01/2021 R10

R10
Revision Effective: 03/08/2021
Revision Explanation: The following ICD-10 codes have been removed, F11.229, F11.259, and F11.29,. There were to be removed during revision 7 but  were left in ICD-10 group1 in error. 

03/08/2021 R9

R9
Revision Effective: 01/01/2021
Revision Explanation: Under CMS National Coverage Policy added the regulation for CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1.2 - A/B MAC (B) Contacts with Independent Clinical Laboratories to this section. This revision has a retroactive effective date of 1/1/21.

Under CPT/HCPCS Codes Group 1: Codes added code 0227U due to the Q1 2021 CPT/HCPCS code update and has a retroactive effective date of 1/1/21.

03/08/2021 R8

R8
Revision Effective: 03/04/2021
Revision Explanation: Annual review, no changes were made.

03/08/2021 R7

R7
Revision Effective: 03/08/2021
Revision Explanation: When draft article was released to final with the policy the updates made in revision 5 from annual ICD-10 update was not added to the released article so it would have the updates. This has been corrected.

Group 1: Codes added codes F10.130, F10.131, F10.132, F10.139, F11.13, F12.13, F13.130, F13.131, F13.132, F13.139, F14.13, F14.93, F15.13, F19.130, F19.131, F19.132, F19.139, G40.42, M25.59, T40.411A, T40.411D, T40.411S, T40.412A, T40.412D, T40.412S, T40.413A, T40.413D, T40.413S, T40.414A, T40.414D, T40.414S, T40.421A, T40.421D, T40.421S, T40.422A, T40.422D, T40.422S, T40.423A, T40.423D, T40.423S, T40.424A, T40.424D, T40.424S, T40.491A, T40.491D, T40.491S, T40.492A, T40.492D, T40.492S, T40.493A, T40.493D, T40.493S, T40.494A, T40.494D, T40.494S, Z03.821, Z03.822, Z03.833, Z91.19 and deleted codes T40.4X1A, T40.4X2A, T40.4X3A, and T40.4X4A. This revision is due to the Annual ICD-10 Code Update and is effective on October 1, 2020. Removed the following unspecified codes as there are more applicable codes available: F11.229, f11.259, f11.29M25.50, M25.59, M60.9, R40.20.

03/08/2021 R6

R6
Revision Effective: 03/08/2021
Revision Explanation: Released article from draft, no changes made as no comments received. Policy in notice from 01/21/2021-03/07/2021. Policy and billing and Coding article effective 03/08/2021.

10/01/2020 R5

R5
Revision Effective:10/01/2020
Revision Explanation: Under ICD-10 Codes that Support Medical Necessity – Group 1: Codes added codes F10.130, F10.131, F10.132, F10.139, F11.13, F12.13, F13.130, F13.131, F13.132, F13.139, F14.13, F14.93, F15.13, F19.130, F19.131, F19.132, F19.139, G40.42, M25.59, T40.411A, T40.411D, T40.411S, T40.412A, T40.412D, T40.412S, T40.413A, T40.413D, T40.413S, T40.414A, T40.414D, T40.414S, T40.421A, T40.421D, T40.421S, T40.422A, T40.422D, T40.422S, T40.423A, T40.423D, T40.423S, T40.424A, T40.424D, T40.424S, T40.491A, T40.491D, T40.491S, T40.492A, T40.492D, T40.492S, T40.493A, T40.493D, T40.493S, T40.494A, T40.494D, T40.494S, Z03.821, Z03.822, Z03.833, Z91.19 and deleted codes T40.4X1A, T40.4X2A, T40.4X3A, and T40.4X4A. This revision is due to the Annual ICD-10 Code Update and is effective on October 1, 2020. Removed the following unspecified codes as there are more applicable codes available: F11.229, f11.259, f11.29M25.50, M25.59, M60.9, R40.20.

01/01/2020 R4

R4

Revision Effective: n/a

Revision Explanation: Annual review, no changes made.

01/01/2020 R3

R3

Revision Effective: 01/01/2020

Revision Explanation: Added new codes 0143U-0150U under CPT section based on annual HCPCS update effective 01/01/2020.

11/21/2019 R2

R2

Revision Effective: 11/21/2019

Revision Explanation: Added regulations in the CMS National policy section and added additional information in the article test concerning the billing of these tests.

09/19/2019 R1

R1

Revision Effective: 09/19/2019

Revision Explanation: Converted article into new Billing and Coding template no other changes made.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L36029 - Urine Drug Testing
Related National Coverage Documents
NCDs
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
02/27/2026 03/05/2026 - N/A Currently in Effect You are here
08/22/2025 08/28/2025 - 03/04/2026 Superseded View
07/24/2025 07/24/2025 - 08/27/2025 Superseded View
07/08/2025 07/17/2025 - 07/23/2025 Superseded View
05/23/2025 05/29/2025 - 07/16/2025 Superseded View
02/25/2025 03/06/2025 - 05/28/2025 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A