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SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Allergy Testing

A57181

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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.
Superseded
To see the currently-in-effect version of this document, go to the section.

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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57181
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Allergy Testing
Article Type
Billing and Coding
Original Effective Date
10/01/2019
Revision Effective Date
04/01/2024
Revision Ending Date
04/24/2024
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (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 312‐893‐6816.

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 (SSA), 1862(a)(1)(A), states that no Medicare payment shall be made for items or services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”

Title XVIII of the Social Security Act, 1862(a)(7) and 42 Code of Federal Regulations, §411.15, exclude routine physical examinations.

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

CMS Manual System, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §110.11; food allergy testing and treatment.

CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §200; allergy testing and immunotherapy.

Article Guidance

Article Text

The following coding and billing guidance is to be used with its associated Local coverage determination.

Documentation Requirements
It is expected that supportive documentation evidencing the condition and treatment will be documented in the medical record and be available to the Contractor upon request.

Documentation, such as ICD-10-CM codes, supporting the medical necessity of the service must be submitted with each claim. Claims submitted without such evidence will be denied as not medically reasonable and necessary.

Utilization Guidelines
The evaluation of an inhalant may require up to 90 prick-puncture tests followed by up to 40 intracutaneous tests which are usually performed when prick/puncture tests are negative. Sometimes 60 intracutaneous tests performed via multi test, in lieu of prick puncture, may be appropriate for selected patients (for example young children, older adults and needle phobic individuals.)

The number of percutaneous tests performed for the evaluation of food sensitivity may require up to 40 tests.

The total number of tests, i.e. prick or intracutaneous, should not exceed generally accepted standards of testing set forth by professional associations. Exceeding these parameters may be justified if preliminary testing failed and immunotherapy failed to control symptoms.

In California, for CPT code 95004, among patients treated by Allergists, over half required fewer than 100 tests. The great majority required less than 120-130 tests, and only 5% required more than 200 tests. Some of the high-test group includes repeat testing necessitated by unsatisfactory response to clinical treatment and a clinical need for further investigation. For CPT code 95024, among patients treated by Allergists, over half required only 12 tests, and only 5% required 70 or more tests. High-utilization testing may be selected for medical review when inconsistent with clinical practice norms.

Response To Comments

Number Comment Response
1
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Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

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Group 1

(16 Codes)
Group 1 Paragraph

N/A

 Group 1 Codes
Code Description
86003 ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, CRUDE ALLERGEN EXTRACT, EACH
86005 ALLERGEN SPECIFIC IGE; QUALITATIVE, MULTIALLERGEN SCREEN (EG, DISK, SPONGE, CARD)
95004 PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REACTION, INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TESTS
95017 ALLERGY TESTING, ANY COMBINATION OF PERCUTANEOUS (SCRATCH, PUNCTURE, PRICK) AND INTRACUTANEOUS (INTRADERMAL), SEQUENTIAL AND INCREMENTAL, WITH VENOMS, IMMEDIATE TYPE REACTION, INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TESTS
95018 ALLERGY TESTING, ANY COMBINATION OF PERCUTANEOUS (SCRATCH, PUNCTURE, PRICK) AND INTRACUTANEOUS (INTRADERMAL), SEQUENTIAL AND INCREMENTAL, WITH DRUGS OR BIOLOGICALS, IMMEDIATE TYPE REACTION, INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TESTS
95024 INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REACTION, INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TESTS
95027 INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH ALLERGENIC EXTRACTS FOR AIRBORNE ALLERGENS, IMMEDIATE TYPE REACTION, INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TESTS
95028 INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, DELAYED TYPE REACTION, INCLUDING READING, SPECIFY NUMBER OF TESTS
95044 PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF TESTS)
95052 PHOTO PATCH TEST(S) (SPECIFY NUMBER OF TESTS)
95056 PHOTO TESTS
95060 OPHTHALMIC MUCOUS MEMBRANE TESTS
95065 DIRECT NASAL MUCOUS MEMBRANE TEST
95070 INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY FUNCTION TESTS), WITH HISTAMINE, METHACHOLINE, OR SIMILAR COMPOUNDS
95076 INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL INGESTION OF TEST ITEMS, EG, FOOD, DRUG OR OTHER SUBSTANCE); INITIAL 120 MINUTES OF TESTING
95079 INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL INGESTION OF TEST ITEMS, EG, FOOD, DRUG OR OTHER SUBSTANCE); EACH ADDITIONAL 60 MINUTES OF TESTING (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
N/A

CPT/HCPCS Modifiers

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Group 1

Group 1 Paragraph

N/A

 Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

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Group 1

(391 Codes)
Group 1 Paragraph

The following list of ICD-10-CM Codes will be covered for CPT Code 86003:

 Group 1 Codes
Code Description
H10.411 Chronic giant papillary conjunctivitis, right eye
H10.412 Chronic giant papillary conjunctivitis, left eye
H10.413 Chronic giant papillary conjunctivitis, bilateral
H10.45 Other chronic allergic conjunctivitis
H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear
H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear
H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral
H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear
H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear
H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral
H65.194 Other acute nonsuppurative otitis media, recurrent, right ear
H65.195 Other acute nonsuppurative otitis media, recurrent, left ear
H65.196 Other acute nonsuppurative otitis media, recurrent, bilateral
H65.21 Chronic serous otitis media, right ear
H65.22 Chronic serous otitis media, left ear
H65.23 Chronic serous otitis media, bilateral
H65.411 Chronic allergic otitis media, right ear
H65.412 Chronic allergic otitis media, left ear
H65.413 Chronic allergic otitis media, bilateral
H65.491 Other chronic nonsuppurative otitis media, right ear
H65.492 Other chronic nonsuppurative otitis media, left ear
H65.493 Other chronic nonsuppurative otitis media, bilateral
H68.021 Chronic Eustachian salpingitis, right ear
H68.022 Chronic Eustachian salpingitis, left ear
H68.023 Chronic Eustachian salpingitis, bilateral
H69.81 Other specified disorders of Eustachian tube, right ear
H69.82 Other specified disorders of Eustachian tube, left ear
H69.83 Other specified disorders of Eustachian tube, bilateral
J20.8 Acute bronchitis due to other specified organisms
J30.0 Vasomotor rhinitis
J30.1 Allergic rhinitis due to pollen
J30.2 Other seasonal allergic rhinitis
J30.5 Allergic rhinitis due to food
J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89 Other allergic rhinitis
J31.0 Chronic rhinitis
J33.0 Polyp of nasal cavity
J33.1 Polypoid sinus degeneration
J33.8 Other polyp of sinus
J33.9 Nasal polyp, unspecified
J34.1 Cyst and mucocele of nose and nasal sinus
J34.81 Nasal mucositis (ulcerative)
J35.01 Chronic tonsillitis
J35.02 Chronic adenoiditis
J35.03 Chronic tonsillitis and adenoiditis
J35.1 Hypertrophy of tonsils
J35.2 Hypertrophy of adenoids
J35.3 Hypertrophy of tonsils with hypertrophy of adenoids
J45.20 Mild intermittent asthma, uncomplicated
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.30 Mild persistent asthma, uncomplicated
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.40 Moderate persistent asthma, uncomplicated
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.50 Severe persistent asthma, uncomplicated
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 Severe persistent asthma with status asthmaticus
J45.901 Unspecified asthma with (acute) exacerbation
J45.902 Unspecified asthma with status asthmaticus
J45.909 Unspecified asthma, uncomplicated
J45.991 Cough variant asthma
J45.998 Other asthma
L20.0 Besnier's prurigo
L20.81 Atopic neurodermatitis
L20.82 Flexural eczema
L20.83 Infantile (acute) (chronic) eczema
L20.84 Intrinsic (allergic) eczema
L20.89 Other atopic dermatitis
L20.9 Atopic dermatitis, unspecified
L27.0 Generalized skin eruption due to drugs and medicaments taken internally
L27.1 Localized skin eruption due to drugs and medicaments taken internally
L27.2 Dermatitis due to ingested food
L27.8 Dermatitis due to other substances taken internally
L27.9 Dermatitis due to unspecified substance taken internally
L30.0 Nummular dermatitis
L30.2 Cutaneous autosensitization
L30.8 Other specified dermatitis
L50.0 Allergic urticaria
L50.1 Idiopathic urticaria
L50.6 Contact urticaria
L50.8 Other urticaria
L50.9 Urticaria, unspecified
R06.00 Dyspnea, unspecified
R06.02 Shortness of breath
R06.09 Other forms of dyspnea
R06.2 Wheezing
R06.9 Unspecified abnormalities of breathing
R09.81 Nasal congestion
R21 Rash and other nonspecific skin eruption
R43.0 Anosmia
R43.1 Parosmia
R43.2 Parageusia
R43.8 Other disturbances of smell and taste
R43.9 Unspecified disturbances of smell and taste
T36.0X5A Adverse effect of penicillins, initial encounter
T36.0X5S Adverse effect of penicillins, sequela
T36.1X5A Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter
T36.1X5S Adverse effect of cephalosporins and other beta-lactam antibiotics, sequela
T36.2X5A Adverse effect of chloramphenicol group, initial encounter
T36.2X5S Adverse effect of chloramphenicol group, sequela
T36.3X5A Adverse effect of macrolides, initial encounter
T36.3X5S Adverse effect of macrolides, sequela
T36.4X5A Adverse effect of tetracyclines, initial encounter
T36.4X5S Adverse effect of tetracyclines, sequela
T36.5X5A Adverse effect of aminoglycosides, initial encounter
T36.5X5S Adverse effect of aminoglycosides, sequela
T36.6X5A Adverse effect of rifampicins, initial encounter
T36.6X5S Adverse effect of rifampicins, sequela
T36.7X5A Adverse effect of antifungal antibiotics, systemically used, initial encounter
T36.7X5S Adverse effect of antifungal antibiotics, systemically used, sequela
T36.8X5A Adverse effect of other systemic antibiotics, initial encounter
T36.8X5S Adverse effect of other systemic antibiotics, sequela
T37.0X5A Adverse effect of sulfonamides, initial encounter
T37.0X5S Adverse effect of sulfonamides, sequela
T37.1X5A Adverse effect of antimycobacterial drugs, initial encounter
T37.1X5S Adverse effect of antimycobacterial drugs, sequela
T37.2X5A Adverse effect of antimalarials and drugs acting on other blood protozoa, initial encounter
T37.2X5S Adverse effect of antimalarials and drugs acting on other blood protozoa, sequela
T37.3X5A Adverse effect of other antiprotozoal drugs, initial encounter
T37.3X5S Adverse effect of other antiprotozoal drugs, sequela
T37.4X5A Adverse effect of anthelminthics, initial encounter
T37.4X5S Adverse effect of anthelminthics, sequela
T37.5X5A Adverse effect of antiviral drugs, initial encounter
T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter
T38.0X5S Adverse effect of glucocorticoids and synthetic analogues, sequela
T38.1X5A Adverse effect of thyroid hormones and substitutes, initial encounter
T38.1X5S Adverse effect of thyroid hormones and substitutes, sequela
T38.2X5A Adverse effect of antithyroid drugs, initial encounter
T38.2X5S Adverse effect of antithyroid drugs, sequela
T38.3X5A Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter
T38.3X5S Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, sequela
T38.4X5A Adverse effect of oral contraceptives, initial encounter
T38.4X5S Adverse effect of oral contraceptives, sequela
T38.5X5A Adverse effect of other estrogens and progestogens, initial encounter
T38.5X5S Adverse effect of other estrogens and progestogens, sequela
T38.6X5A Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, initial encounter
T38.6X5S Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, sequela
T38.7X5A Adverse effect of androgens and anabolic congeners, initial encounter
T38.7X5S Adverse effect of androgens and anabolic congeners, sequela
T38.815A Adverse effect of anterior pituitary [adenohypophyseal] hormones, initial encounter
T38.815S Adverse effect of anterior pituitary [adenohypophyseal] hormones, sequela
T38.895A Adverse effect of other hormones and synthetic substitutes, initial encounter
T38.895S Adverse effect of other hormones and synthetic substitutes, sequela
T38.995A Adverse effect of other hormone antagonists, initial encounter
T38.995S Adverse effect of other hormone antagonists, sequela
T39.015A Adverse effect of aspirin, initial encounter
T39.015S Adverse effect of aspirin, sequela
T39.095A Adverse effect of salicylates, initial encounter
T39.095S Adverse effect of salicylates, sequela
T39.1X5A Adverse effect of 4-Aminophenol derivatives, initial encounter
T39.1X5S Adverse effect of 4-Aminophenol derivatives, sequela
T39.2X5A Adverse effect of pyrazolone derivatives, initial encounter
T39.2X5S Adverse effect of pyrazolone derivatives, sequela
T39.315A Adverse effect of propionic acid derivatives, initial encounter
T39.315S Adverse effect of propionic acid derivatives, sequela
T39.395A Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], initial encounter
T39.395S Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], sequela
T39.4X5A Adverse effect of antirheumatics, not elsewhere classified, initial encounter
T39.4X5S Adverse effect of antirheumatics, not elsewhere classified, sequela
T39.8X5A Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, initial encounter
T39.8X5S Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, sequela
T40.0X5A Adverse effect of opium, initial encounter
T40.0X5S Adverse effect of opium, sequela
T40.2X5A Adverse effect of other opioids, initial encounter
T40.2X5S Adverse effect of other opioids, sequela
T40.3X5A Adverse effect of methadone, initial encounter
T40.3X5S Adverse effect of methadone, sequela
T40.415A Adverse effect of fentanyl or fentanyl analogs, initial encounter
T40.415S Adverse effect of fentanyl or fentanyl analogs, sequela
T40.425A Adverse effect of tramadol, initial encounter
T40.425S Adverse effect of tramadol, sequela
T40.495A Adverse effect of other synthetic narcotics, initial encounter
T40.495S Adverse effect of other synthetic narcotics, sequela
T40.5X5A Adverse effect of cocaine, initial encounter
T40.5X5S Adverse effect of cocaine, sequela
T40.695A Adverse effect of other narcotics, initial encounter
T40.695S Adverse effect of other narcotics, sequela
T40.995A Adverse effect of other psychodysleptics [hallucinogens], initial encounter
T40.995S Adverse effect of other psychodysleptics [hallucinogens], sequela
T41.0X5A Adverse effect of inhaled anesthetics, initial encounter
T41.0X5S Adverse effect of inhaled anesthetics, sequela
T41.1X5A Adverse effect of intravenous anesthetics, initial encounter
T41.1X5S Adverse effect of intravenous anesthetics, sequela
T41.295A Adverse effect of other general anesthetics, initial encounter
T41.295S Adverse effect of other general anesthetics, sequela
T41.3X5A Adverse effect of local anesthetics, initial encounter
T41.3X5S Adverse effect of local anesthetics, sequela
T41.5X5A Adverse effect of therapeutic gases, initial encounter
T41.5X5S Adverse effect of therapeutic gases, sequela
T42.0X5A Adverse effect of hydantoin derivatives, initial encounter
T42.0X5S Adverse effect of hydantoin derivatives, sequela
T42.1X5A Adverse effect of iminostilbenes, initial encounter
T42.1X5S Adverse effect of iminostilbenes, sequela
T42.2X5A Adverse effect of succinimides and oxazolidinediones, initial encounter
T42.2X5S Adverse effect of succinimides and oxazolidinediones, sequela
T42.3X5A Adverse effect of barbiturates, initial encounter
T42.4X5A Adverse effect of benzodiazepines, initial encounter
T42.4X5S Adverse effect of benzodiazepines, sequela
T42.5X5A Adverse effect of mixed antiepileptics, initial encounter
T42.5X5S Adverse effect of mixed antiepileptics, sequela
T42.6X5A Adverse effect of other antiepileptic and sedative-hypnotic drugs, initial encounter
T42.6X5S Adverse effect of other antiepileptic and sedative-hypnotic drugs, sequela
T42.8X5A Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, initial encounter
T42.8X5S Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, sequela
T43.015A Adverse effect of tricyclic antidepressants, initial encounter
T43.015S Adverse effect of tricyclic antidepressants, sequela
T43.025A Adverse effect of tetracyclic antidepressants, initial encounter
T43.025S Adverse effect of tetracyclic antidepressants, sequela
T43.1X5A Adverse effect of monoamine-oxidase-inhibitor antidepressants, initial encounter
T43.1X5S Adverse effect of monoamine-oxidase-inhibitor antidepressants, sequela
T43.215A Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, initial encounter
T43.215S Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, sequela
T43.225A Adverse effect of selective serotonin reuptake inhibitors, initial encounter
T43.225S Adverse effect of selective serotonin reuptake inhibitors, sequela
T43.295A Adverse effect of other antidepressants, initial encounter
T43.295S Adverse effect of other antidepressants, sequela
T43.3X5A Adverse effect of phenothiazine antipsychotics and neuroleptics, initial encounter
T43.3X5S Adverse effect of phenothiazine antipsychotics and neuroleptics, sequela
T43.4X5A Adverse effect of butyrophenone and thiothixene neuroleptics, initial encounter
T43.4X5S Adverse effect of butyrophenone and thiothixene neuroleptics, sequela
T43.595A Adverse effect of other antipsychotics and neuroleptics, initial encounter
T43.595S Adverse effect of other antipsychotics and neuroleptics, sequela
T43.615A Adverse effect of caffeine, initial encounter
T43.615S Adverse effect of caffeine, sequela
T43.625A Adverse effect of amphetamines, initial encounter
T43.625S Adverse effect of amphetamines, sequela
T43.635A Adverse effect of methylphenidate, initial encounter
T43.635S Adverse effect of methylphenidate, sequela
T43.655A Adverse effect of methamphetamines, initial encounter
T43.655D Adverse effect of methamphetamines, subsequent encounter
T43.655S Adverse effect of methamphetamines, sequela
T43.695A Adverse effect of other psychostimulants, initial encounter
T43.695S Adverse effect of other psychostimulants, sequela
T43.8X5A Adverse effect of other psychotropic drugs, initial encounter
T43.8X5S Adverse effect of other psychotropic drugs, sequela
T44.0X5A Adverse effect of anticholinesterase agents, initial encounter
T44.0X5S Adverse effect of anticholinesterase agents, sequela
T44.1X5A Adverse effect of other parasympathomimetics [cholinergics], initial encounter
T44.1X5S Adverse effect of other parasympathomimetics [cholinergics], sequela
T44.2X5A Adverse effect of ganglionic blocking drugs, initial encounter
T44.2X5S Adverse effect of ganglionic blocking drugs, sequela
T44.3X5A Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, initial encounter
T44.3X5S Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, sequela
T44.4X5A Adverse effect of predominantly alpha-adrenoreceptor agonists, initial encounter
T44.4X5S Adverse effect of predominantly alpha-adrenoreceptor agonists, sequela
T44.5X5A Adverse effect of predominantly beta-adrenoreceptor agonists, initial encounter
T44.5X5S Adverse effect of predominantly beta-adrenoreceptor agonists, sequela
T44.6X5A Adverse effect of alpha-adrenoreceptor antagonists, initial encounter
T44.6X5S Adverse effect of alpha-adrenoreceptor antagonists, sequela
T44.7X5A Adverse effect of beta-adrenoreceptor antagonists, initial encounter
T44.7X5S Adverse effect of beta-adrenoreceptor antagonists, sequela
T44.8X5A Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, initial encounter
T44.8X5S Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, sequela
T44.995A Adverse effect of other drug primarily affecting the autonomic nervous system, initial encounter
T44.995S Adverse effect of other drug primarily affecting the autonomic nervous system, sequela
T45.0X5A Adverse effect of antiallergic and antiemetic drugs, initial encounter
T45.0X5S Adverse effect of antiallergic and antiemetic drugs, sequela
T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
T45.1X5S Adverse effect of antineoplastic and immunosuppressive drugs, sequela
T45.2X5A Adverse effect of vitamins, initial encounter
T45.2X5S Adverse effect of vitamins, sequela
T45.3X5A Adverse effect of enzymes, initial encounter
T45.3X5S Adverse effect of enzymes, sequela
T45.4X5A Adverse effect of iron and its compounds, initial encounter
T45.4X5S Adverse effect of iron and its compounds, sequela
T45.515A Adverse effect of anticoagulants, initial encounter
T45.515S Adverse effect of anticoagulants, sequela
T45.525A Adverse effect of antithrombotic drugs, initial encounter
T45.525S Adverse effect of antithrombotic drugs, sequela
T45.615A Adverse effect of thrombolytic drugs, initial encounter
T45.615S Adverse effect of thrombolytic drugs, sequela
T45.625A Adverse effect of hemostatic drug, initial encounter
T45.625S Adverse effect of hemostatic drug, sequela
T45.695A Adverse effect of other fibrinolysis-affecting drugs, initial encounter
T45.695S Adverse effect of other fibrinolysis-affecting drugs, sequela
T45.7X5A Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, initial encounter
T45.7X5S Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, sequela
T45.8X5A Adverse effect of other primarily systemic and hematological agents, initial encounter
T45.8X5S Adverse effect of other primarily systemic and hematological agents, sequela
T46.0X5A Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter
T46.0X5S Adverse effect of cardiac-stimulant glycosides and drugs of similar action, sequela
T46.1X5A Adverse effect of calcium-channel blockers, initial encounter
T46.1X5S Adverse effect of calcium-channel blockers, sequela
T46.2X5A Adverse effect of other antidysrhythmic drugs, initial encounter
T46.2X5S Adverse effect of other antidysrhythmic drugs, sequela
T46.3X5A Adverse effect of coronary vasodilators, initial encounter
T46.3X5S Adverse effect of coronary vasodilators, sequela
T46.4X5A Adverse effect of angiotensin-converting-enzyme inhibitors, initial encounter
T46.4X5S Adverse effect of angiotensin-converting-enzyme inhibitors, sequela
T46.5X5A Adverse effect of other antihypertensive drugs, initial encounter
T46.5X5S Adverse effect of other antihypertensive drugs, sequela
T46.6X5A Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter
T46.6X5S Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, sequela
T46.7X5A Adverse effect of peripheral vasodilators, initial encounter
T46.7X5S Adverse effect of peripheral vasodilators, sequela
T46.8X5A Adverse effect of antivaricose drugs, including sclerosing agents, initial encounter
T46.8X5S Adverse effect of antivaricose drugs, including sclerosing agents, sequela
T46.995A Adverse effect of other agents primarily affecting the cardiovascular system, initial encounter
T46.995S Adverse effect of other agents primarily affecting the cardiovascular system, sequela
T47.0X5A Adverse effect of histamine H2-receptor blockers, initial encounter
T47.0X5S Adverse effect of histamine H2-receptor blockers, sequela
T47.1X5A Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter
T47.1X5S Adverse effect of other antacids and anti-gastric-secretion drugs, sequela
T47.2X5A Adverse effect of stimulant laxatives, initial encounter
T47.2X5S Adverse effect of stimulant laxatives, sequela
T47.3X5A Adverse effect of saline and osmotic laxatives, initial encounter
T47.3X5S Adverse effect of saline and osmotic laxatives, sequela
T47.4X5A Adverse effect of other laxatives, initial encounter
T47.4X5S Adverse effect of other laxatives, sequela
T47.5X5A Adverse effect of digestants, initial encounter
T47.5X5S Adverse effect of digestants, sequela
T47.6X5A Adverse effect of antidiarrheal drugs, initial encounter
T47.6X5S Adverse effect of antidiarrheal drugs, sequela
T47.7X5A Adverse effect of emetics, initial encounter
T47.7X5S Adverse effect of emetics, sequela
T47.8X5A Adverse effect of other agents primarily affecting gastrointestinal system, initial encounter
T47.8X5S Adverse effect of other agents primarily affecting gastrointestinal system, sequela
T48.0X5A Adverse effect of oxytocic drugs, initial encounter
T48.0X5S Adverse effect of oxytocic drugs, sequela
T48.1X5A Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], initial encounter
T48.1X5S Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], sequela
T48.295A Adverse effect of other drugs acting on muscles, initial encounter
T48.295S Adverse effect of other drugs acting on muscles, sequela
T48.3X5A Adverse effect of antitussives, initial encounter
T48.3X5S Adverse effect of antitussives, sequela
T48.4X5A Adverse effect of expectorants, initial encounter
T48.4X5S Adverse effect of expectorants, sequela
T48.5X5A Adverse effect of other anti-common-cold drugs, initial encounter
T48.5X5S Adverse effect of other anti-common-cold drugs, sequela
T48.6X5A Adverse effect of antiasthmatics, initial encounter
T48.6X5S Adverse effect of antiasthmatics, sequela
T48.995A Adverse effect of other agents primarily acting on the respiratory system, initial encounter
T48.995S Adverse effect of other agents primarily acting on the respiratory system, sequela
T49.0X5A Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, initial encounter
T49.0X5S Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, sequela
T49.1X5A Adverse effect of antipruritics, initial encounter
T49.1X5S Adverse effect of antipruritics, sequela
T49.2X5A Adverse effect of local astringents and local detergents, initial encounter
T49.2X5S Adverse effect of local astringents and local detergents, sequela
T49.3X5A Adverse effect of emollients, demulcents and protectants, initial encounter
T49.3X5S Adverse effect of emollients, demulcents and protectants, sequela
T49.4X5A Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, initial encounter
T49.4X5S Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, sequela
T49.5X5A Adverse effect of ophthalmological drugs and preparations, initial encounter
T49.5X5S Adverse effect of ophthalmological drugs and preparations, sequela
T49.6X5A Adverse effect of otorhinolaryngological drugs and preparations, initial encounter
T49.6X5S Adverse effect of otorhinolaryngological drugs and preparations, sequela
T49.7X5A Adverse effect of dental drugs, topically applied, initial encounter
T49.7X5S Adverse effect of dental drugs, topically applied, sequela
T49.8X5A Adverse effect of other topical agents, initial encounter
T49.8X5S Adverse effect of other topical agents, sequela
T50.0X5A Adverse effect of mineralocorticoids and their antagonists, initial encounter
T50.0X5S Adverse effect of mineralocorticoids and their antagonists, sequela
T50.1X5A Adverse effect of loop [high-ceiling] diuretics, initial encounter
T50.1X5S Adverse effect of loop [high-ceiling] diuretics, sequela
T50.2X5A Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter
T50.2X5S Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, sequela
T50.3X5A Adverse effect of electrolytic, caloric and water-balance agents, initial encounter
T50.3X5S Adverse effect of electrolytic, caloric and water-balance agents, sequela
T50.4X5A Adverse effect of drugs affecting uric acid metabolism, initial encounter
T50.4X5S Adverse effect of drugs affecting uric acid metabolism, sequela
T50.5X5A Adverse effect of appetite depressants, initial encounter
T50.5X5S Adverse effect of appetite depressants, sequela
T50.6X5A Adverse effect of antidotes and chelating agents, initial encounter
T50.6X5S Adverse effect of antidotes and chelating agents, sequela
T50.7X5A Adverse effect of analeptics and opioid receptor antagonists, initial encounter
T50.7X5S Adverse effect of analeptics and opioid receptor antagonists, sequela
T50.8X5A Adverse effect of diagnostic agents, initial encounter
T50.8X5S Adverse effect of diagnostic agents, sequela
T50.A15A Adverse effect of pertussis vaccine, including combinations with a pertussis component, initial encounter
T50.A15S Adverse effect of pertussis vaccine, including combinations with a pertussis component, sequela
T50.A25A Adverse effect of mixed bacterial vaccines without a pertussis component, initial encounter
T50.A25S Adverse effect of mixed bacterial vaccines without a pertussis component, sequela
T50.A95A Adverse effect of other bacterial vaccines, initial encounter
T50.A95S Adverse effect of other bacterial vaccines, sequela
T50.B15A Adverse effect of smallpox vaccines, initial encounter
T50.B15S Adverse effect of smallpox vaccines, sequela
T50.B95A Adverse effect of other viral vaccines, initial encounter
T50.B95S Adverse effect of other viral vaccines, sequela
T50.Z15A Adverse effect of immunoglobulin, initial encounter
T50.Z15S Adverse effect of immunoglobulin, sequela
T50.Z95A Adverse effect of other vaccines and biological substances, initial encounter
T50.Z95S Adverse effect of other vaccines and biological substances, sequela
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
T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela

Group 2

(419 Codes)
Group 2 Paragraph

The following list of ICD-10-CM Codes will be covered for CPT Codes 95004, 95017, 95018, 95024, 95027, 95028, 95060, 95065, 95070, 95076 and 95079:

 Group 2 Codes
Code Description
H10.411 Chronic giant papillary conjunctivitis, right eye
H10.412 Chronic giant papillary conjunctivitis, left eye
H10.413 Chronic giant papillary conjunctivitis, bilateral
H10.45 Other chronic allergic conjunctivitis
H65.04 Acute serous otitis media, recurrent, right ear
H65.05 Acute serous otitis media, recurrent, left ear
H65.06 Acute serous otitis media, recurrent, bilateral
H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear
H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear
H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral
H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear
H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear
H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral
H65.194 Other acute nonsuppurative otitis media, recurrent, right ear
H65.195 Other acute nonsuppurative otitis media, recurrent, left ear
H65.196 Other acute nonsuppurative otitis media, recurrent, bilateral
H65.21 Chronic serous otitis media, right ear
H65.22 Chronic serous otitis media, left ear
H65.23 Chronic serous otitis media, bilateral
H65.411 Chronic allergic otitis media, right ear
H65.412 Chronic allergic otitis media, left ear
H65.413 Chronic allergic otitis media, bilateral
H65.491 Other chronic nonsuppurative otitis media, right ear
H65.492 Other chronic nonsuppurative otitis media, left ear
H65.493 Other chronic nonsuppurative otitis media, bilateral
H68.021 Chronic Eustachian salpingitis, right ear
H68.022 Chronic Eustachian salpingitis, left ear
H68.023 Chronic Eustachian salpingitis, bilateral
J30.0 Vasomotor rhinitis
J30.1 Allergic rhinitis due to pollen
J30.2 Other seasonal allergic rhinitis
J30.5 Allergic rhinitis due to food
J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89 Other allergic rhinitis
J31.0 Chronic rhinitis
J33.1 Polypoid sinus degeneration
J33.8 Other polyp of sinus
J34.1 Cyst and mucocele of nose and nasal sinus
J34.81 Nasal mucositis (ulcerative)
J35.01 Chronic tonsillitis
J35.02 Chronic adenoiditis
J35.03 Chronic tonsillitis and adenoiditis
J35.1 Hypertrophy of tonsils
J35.2 Hypertrophy of adenoids
J35.3 Hypertrophy of tonsils with hypertrophy of adenoids
J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
J44.89 Other specified chronic obstructive pulmonary disease
J45.20 Mild intermittent asthma, uncomplicated
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.30 Mild persistent asthma, uncomplicated
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.40 Moderate persistent asthma, uncomplicated
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.50 Severe persistent asthma, uncomplicated
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 Severe persistent asthma with status asthmaticus
J45.991 Cough variant asthma
J45.998 Other asthma
L20.0 Besnier's prurigo
L20.81 Atopic neurodermatitis
L20.82 Flexural eczema
L20.84 Intrinsic (allergic) eczema
L20.89 Other atopic dermatitis
L27.0 Generalized skin eruption due to drugs and medicaments taken internally
L27.1 Localized skin eruption due to drugs and medicaments taken internally
L27.2 Dermatitis due to ingested food
L27.8 Dermatitis due to other substances taken internally
L29.9 Pruritus, unspecified
L50.0 Allergic urticaria
L50.1 Idiopathic urticaria
L50.6 Contact urticaria
L50.8 Other urticaria
L50.9 Urticaria, unspecified
R05.2 Subacute cough
R05.3 Chronic cough
R05.8 Other specified cough
R05.9 Cough, unspecified
R06.02 Shortness of breath
R06.2 Wheezing
R09.81 Nasal congestion
R21 Rash and other nonspecific skin eruption
R23.8 Other skin changes
R23.9 Unspecified skin changes
R43.0 Anosmia
R43.1 Parosmia
R43.2 Parageusia
R43.8 Other disturbances of smell and taste
R43.9 Unspecified disturbances of smell and taste
T36.0X5A Adverse effect of penicillins, initial encounter
T36.0X5S Adverse effect of penicillins, sequela
T36.1X5A Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter
T36.1X5S Adverse effect of cephalosporins and other beta-lactam antibiotics, sequela
T36.2X5A Adverse effect of chloramphenicol group, initial encounter
T36.2X5S Adverse effect of chloramphenicol group, sequela
T36.3X5A Adverse effect of macrolides, initial encounter
T36.3X5S Adverse effect of macrolides, sequela
T36.4X5A Adverse effect of tetracyclines, initial encounter
T36.4X5S Adverse effect of tetracyclines, sequela
T36.5X5A Adverse effect of aminoglycosides, initial encounter
T36.5X5S Adverse effect of aminoglycosides, sequela
T36.6X5A Adverse effect of rifampicins, initial encounter
T36.6X5S Adverse effect of rifampicins, sequela
T36.7X5A Adverse effect of antifungal antibiotics, systemically used, initial encounter
T36.7X5S Adverse effect of antifungal antibiotics, systemically used, sequela
T36.8X5A Adverse effect of other systemic antibiotics, initial encounter
T36.8X5S Adverse effect of other systemic antibiotics, sequela
T37.0X5A Adverse effect of sulfonamides, initial encounter
T37.0X5S Adverse effect of sulfonamides, sequela
T37.1X5A Adverse effect of antimycobacterial drugs, initial encounter
T37.1X5S Adverse effect of antimycobacterial drugs, sequela
T37.2X5A Adverse effect of antimalarials and drugs acting on other blood protozoa, initial encounter
T37.2X5S Adverse effect of antimalarials and drugs acting on other blood protozoa, sequela
T37.3X5A Adverse effect of other antiprotozoal drugs, initial encounter
T37.3X5S Adverse effect of other antiprotozoal drugs, sequela
T37.4X5A Adverse effect of anthelminthics, initial encounter
T37.4X5S Adverse effect of anthelminthics, sequela
T37.5X5A Adverse effect of antiviral drugs, initial encounter
T37.5X5S Adverse effect of antiviral drugs, sequela
T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter
T38.0X5S Adverse effect of glucocorticoids and synthetic analogues, sequela
T38.1X5A Adverse effect of thyroid hormones and substitutes, initial encounter
T38.1X5S Adverse effect of thyroid hormones and substitutes, sequela
T38.2X5A Adverse effect of antithyroid drugs, initial encounter
T38.2X5S Adverse effect of antithyroid drugs, sequela
T38.3X5A Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter
T38.3X5S Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, sequela
T38.4X5A Adverse effect of oral contraceptives, initial encounter
T38.4X5S Adverse effect of oral contraceptives, sequela
T38.5X5A Adverse effect of other estrogens and progestogens, initial encounter
T38.5X5S Adverse effect of other estrogens and progestogens, sequela
T38.6X5A Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, initial encounter
T38.6X5S Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, sequela
T38.7X5A Adverse effect of androgens and anabolic congeners, initial encounter
T38.7X5S Adverse effect of androgens and anabolic congeners, sequela
T38.815A Adverse effect of anterior pituitary [adenohypophyseal] hormones, initial encounter
T38.815S Adverse effect of anterior pituitary [adenohypophyseal] hormones, sequela
T38.895A Adverse effect of other hormones and synthetic substitutes, initial encounter
T38.895S Adverse effect of other hormones and synthetic substitutes, sequela
T38.995A Adverse effect of other hormone antagonists, initial encounter
T38.995S Adverse effect of other hormone antagonists, sequela
T39.015A Adverse effect of aspirin, initial encounter
T39.015S Adverse effect of aspirin, sequela
T39.095A Adverse effect of salicylates, initial encounter
T39.095S Adverse effect of salicylates, sequela
T39.1X5A Adverse effect of 4-Aminophenol derivatives, initial encounter
T39.1X5S Adverse effect of 4-Aminophenol derivatives, sequela
T39.2X5A Adverse effect of pyrazolone derivatives, initial encounter
T39.2X5S Adverse effect of pyrazolone derivatives, sequela
T39.315A Adverse effect of propionic acid derivatives, initial encounter
T39.315S Adverse effect of propionic acid derivatives, sequela
T39.395A Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], initial encounter
T39.395S Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], sequela
T39.4X5A Adverse effect of antirheumatics, not elsewhere classified, initial encounter
T39.4X5S Adverse effect of antirheumatics, not elsewhere classified, sequela
T39.8X5A Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, initial encounter
T39.8X5S Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, sequela
T40.0X5A Adverse effect of opium, initial encounter
T40.0X5S Adverse effect of opium, sequela
T40.2X5A Adverse effect of other opioids, initial encounter
T40.2X5S Adverse effect of other opioids, sequela
T40.3X5A Adverse effect of methadone, initial encounter
T40.3X5S Adverse effect of methadone, sequela
T40.415A Adverse effect of fentanyl or fentanyl analogs, initial encounter
T40.415S Adverse effect of fentanyl or fentanyl analogs, sequela
T40.425A Adverse effect of tramadol, initial encounter
T40.425S Adverse effect of tramadol, sequela
T40.495A Adverse effect of other synthetic narcotics, initial encounter
T40.495S Adverse effect of other synthetic narcotics, sequela
T40.5X5A Adverse effect of cocaine, initial encounter
T40.5X5S Adverse effect of cocaine, sequela
T40.695A Adverse effect of other narcotics, initial encounter
T40.695S Adverse effect of other narcotics, sequela
T40.995A Adverse effect of other psychodysleptics [hallucinogens], initial encounter
T40.995S Adverse effect of other psychodysleptics [hallucinogens], sequela
T41.0X5A Adverse effect of inhaled anesthetics, initial encounter
T41.0X5S Adverse effect of inhaled anesthetics, sequela
T41.1X5A Adverse effect of intravenous anesthetics, initial encounter
T41.1X5S Adverse effect of intravenous anesthetics, sequela
T41.295A Adverse effect of other general anesthetics, initial encounter
T41.295S Adverse effect of other general anesthetics, sequela
T41.3X5A Adverse effect of local anesthetics, initial encounter
T41.3X5S Adverse effect of local anesthetics, sequela
T41.5X5A Adverse effect of therapeutic gases, initial encounter
T41.5X5S Adverse effect of therapeutic gases, sequela
T42.0X5A Adverse effect of hydantoin derivatives, initial encounter
T42.0X5S Adverse effect of hydantoin derivatives, sequela
T42.1X5A Adverse effect of iminostilbenes, initial encounter
T42.1X5S Adverse effect of iminostilbenes, sequela
T42.2X5A Adverse effect of succinimides and oxazolidinediones, initial encounter
T42.2X5S Adverse effect of succinimides and oxazolidinediones, sequela
T42.3X5A Adverse effect of barbiturates, initial encounter
T42.3X5S Adverse effect of barbiturates, sequela
T42.4X5A Adverse effect of benzodiazepines, initial encounter
T42.4X5S Adverse effect of benzodiazepines, sequela
T42.5X5A Adverse effect of mixed antiepileptics, initial encounter
T42.5X5S Adverse effect of mixed antiepileptics, sequela
T42.6X5A Adverse effect of other antiepileptic and sedative-hypnotic drugs, initial encounter
T42.6X5S Adverse effect of other antiepileptic and sedative-hypnotic drugs, sequela
T42.8X5A Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, initial encounter
T42.8X5S Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, sequela
T43.015A Adverse effect of tricyclic antidepressants, initial encounter
T43.015S Adverse effect of tricyclic antidepressants, sequela
T43.025A Adverse effect of tetracyclic antidepressants, initial encounter
T43.025S Adverse effect of tetracyclic antidepressants, sequela
T43.1X5A Adverse effect of monoamine-oxidase-inhibitor antidepressants, initial encounter
T43.1X5S Adverse effect of monoamine-oxidase-inhibitor antidepressants, sequela
T43.215A Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, initial encounter
T43.215S Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, sequela
T43.225A Adverse effect of selective serotonin reuptake inhibitors, initial encounter
T43.225S Adverse effect of selective serotonin reuptake inhibitors, sequela
T43.295A Adverse effect of other antidepressants, initial encounter
T43.295S Adverse effect of other antidepressants, sequela
T43.3X5A Adverse effect of phenothiazine antipsychotics and neuroleptics, initial encounter
T43.3X5S Adverse effect of phenothiazine antipsychotics and neuroleptics, sequela
T43.4X5A Adverse effect of butyrophenone and thiothixene neuroleptics, initial encounter
T43.4X5S Adverse effect of butyrophenone and thiothixene neuroleptics, sequela
T43.595A Adverse effect of other antipsychotics and neuroleptics, initial encounter
T43.595S Adverse effect of other antipsychotics and neuroleptics, sequela
T43.615A Adverse effect of caffeine, initial encounter
T43.615S Adverse effect of caffeine, sequela
T43.625A Adverse effect of amphetamines, initial encounter
T43.625S Adverse effect of amphetamines, sequela
T43.635A Adverse effect of methylphenidate, initial encounter
T43.635S Adverse effect of methylphenidate, sequela
T43.655A Adverse effect of methamphetamines, initial encounter
T43.655D Adverse effect of methamphetamines, subsequent encounter
T43.655S Adverse effect of methamphetamines, sequela
T43.695A Adverse effect of other psychostimulants, initial encounter
T43.695S Adverse effect of other psychostimulants, sequela
T43.8X5A Adverse effect of other psychotropic drugs, initial encounter
T43.8X5S Adverse effect of other psychotropic drugs, sequela
T44.0X5A Adverse effect of anticholinesterase agents, initial encounter
T44.0X5S Adverse effect of anticholinesterase agents, sequela
T44.1X5A Adverse effect of other parasympathomimetics [cholinergics], initial encounter
T44.1X5S Adverse effect of other parasympathomimetics [cholinergics], sequela
T44.2X5A Adverse effect of ganglionic blocking drugs, initial encounter
T44.2X5S Adverse effect of ganglionic blocking drugs, sequela
T44.3X5A Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, initial encounter
T44.3X5S Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, sequela
T44.4X5A Adverse effect of predominantly alpha-adrenoreceptor agonists, initial encounter
T44.4X5S Adverse effect of predominantly alpha-adrenoreceptor agonists, sequela
T44.5X5A Adverse effect of predominantly beta-adrenoreceptor agonists, initial encounter
T44.5X5S Adverse effect of predominantly beta-adrenoreceptor agonists, sequela
T44.6X5A Adverse effect of alpha-adrenoreceptor antagonists, initial encounter
T44.6X5S Adverse effect of alpha-adrenoreceptor antagonists, sequela
T44.7X5A Adverse effect of beta-adrenoreceptor antagonists, initial encounter
T44.7X5S Adverse effect of beta-adrenoreceptor antagonists, sequela
T44.8X5A Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, initial encounter
T44.8X5S Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, sequela
T44.995A Adverse effect of other drug primarily affecting the autonomic nervous system, initial encounter
T44.995S Adverse effect of other drug primarily affecting the autonomic nervous system, sequela
T45.0X5A Adverse effect of antiallergic and antiemetic drugs, initial encounter
T45.0X5S Adverse effect of antiallergic and antiemetic drugs, sequela
T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
T45.1X5S Adverse effect of antineoplastic and immunosuppressive drugs, sequela
T45.2X5A Adverse effect of vitamins, initial encounter
T45.2X5S Adverse effect of vitamins, sequela
T45.3X5A Adverse effect of enzymes, initial encounter
T45.3X5S Adverse effect of enzymes, sequela
T45.4X5A Adverse effect of iron and its compounds, initial encounter
T45.4X5S Adverse effect of iron and its compounds, sequela
T45.515A Adverse effect of anticoagulants, initial encounter
T45.515S Adverse effect of anticoagulants, sequela
T45.525A Adverse effect of antithrombotic drugs, initial encounter
T45.525S Adverse effect of antithrombotic drugs, sequela
T45.615A Adverse effect of thrombolytic drugs, initial encounter
T45.615S Adverse effect of thrombolytic drugs, sequela
T45.625A Adverse effect of hemostatic drug, initial encounter
T45.625S Adverse effect of hemostatic drug, sequela
T45.695A Adverse effect of other fibrinolysis-affecting drugs, initial encounter
T45.695S Adverse effect of other fibrinolysis-affecting drugs, sequela
T45.7X5A Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, initial encounter
T45.7X5S Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, sequela
T45.8X5A Adverse effect of other primarily systemic and hematological agents, initial encounter
T45.8X5S Adverse effect of other primarily systemic and hematological agents, sequela
T46.0X5A Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter
T46.0X5S Adverse effect of cardiac-stimulant glycosides and drugs of similar action, sequela
T46.1X5A Adverse effect of calcium-channel blockers, initial encounter
T46.1X5S Adverse effect of calcium-channel blockers, sequela
T46.2X5A Adverse effect of other antidysrhythmic drugs, initial encounter
T46.2X5S Adverse effect of other antidysrhythmic drugs, sequela
T46.3X5A Adverse effect of coronary vasodilators, initial encounter
T46.3X5S Adverse effect of coronary vasodilators, sequela
T46.4X5A Adverse effect of angiotensin-converting-enzyme inhibitors, initial encounter
T46.4X5S Adverse effect of angiotensin-converting-enzyme inhibitors, sequela
T46.5X5A Adverse effect of other antihypertensive drugs, initial encounter
T46.5X5S Adverse effect of other antihypertensive drugs, sequela
T46.6X5A Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter
T46.6X5S Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, sequela
T46.7X5A Adverse effect of peripheral vasodilators, initial encounter
T46.7X5S Adverse effect of peripheral vasodilators, sequela
T46.8X5A Adverse effect of antivaricose drugs, including sclerosing agents, initial encounter
T46.8X5S Adverse effect of antivaricose drugs, including sclerosing agents, sequela
T46.995A Adverse effect of other agents primarily affecting the cardiovascular system, initial encounter
T46.995S Adverse effect of other agents primarily affecting the cardiovascular system, sequela
T47.0X5A Adverse effect of histamine H2-receptor blockers, initial encounter
T47.0X5S Adverse effect of histamine H2-receptor blockers, sequela
T47.1X5A Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter
T47.1X5S Adverse effect of other antacids and anti-gastric-secretion drugs, sequela
T47.2X5A Adverse effect of stimulant laxatives, initial encounter
T47.2X5S Adverse effect of stimulant laxatives, sequela
T47.3X5A Adverse effect of saline and osmotic laxatives, initial encounter
T47.3X5S Adverse effect of saline and osmotic laxatives, sequela
T47.4X5A Adverse effect of other laxatives, initial encounter
T47.4X5S Adverse effect of other laxatives, sequela
T47.5X5A Adverse effect of digestants, initial encounter
T47.5X5S Adverse effect of digestants, sequela
T47.6X5A Adverse effect of antidiarrheal drugs, initial encounter
T47.6X5S Adverse effect of antidiarrheal drugs, sequela
T47.7X5A Adverse effect of emetics, initial encounter
T47.7X5S Adverse effect of emetics, sequela
T47.8X5A Adverse effect of other agents primarily affecting gastrointestinal system, initial encounter
T47.8X5S Adverse effect of other agents primarily affecting gastrointestinal system, sequela
T48.0X5A Adverse effect of oxytocic drugs, initial encounter
T48.0X5S Adverse effect of oxytocic drugs, sequela
T48.1X5A Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], initial encounter
T48.1X5S Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], sequela
T48.295A Adverse effect of other drugs acting on muscles, initial encounter
T48.295S Adverse effect of other drugs acting on muscles, sequela
T48.3X5A Adverse effect of antitussives, initial encounter
T48.3X5S Adverse effect of antitussives, sequela
T48.4X5A Adverse effect of expectorants, initial encounter
T48.4X5S Adverse effect of expectorants, sequela
T48.5X5A Adverse effect of other anti-common-cold drugs, initial encounter
T48.5X5S Adverse effect of other anti-common-cold drugs, sequela
T48.6X5A Adverse effect of antiasthmatics, initial encounter
T48.6X5S Adverse effect of antiasthmatics, sequela
T48.995A Adverse effect of other agents primarily acting on the respiratory system, initial encounter
T48.995S Adverse effect of other agents primarily acting on the respiratory system, sequela
T49.0X5A Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, initial encounter
T49.0X5S Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, sequela
T49.1X5A Adverse effect of antipruritics, initial encounter
T49.1X5S Adverse effect of antipruritics, sequela
T49.2X5A Adverse effect of local astringents and local detergents, initial encounter
T49.2X5S Adverse effect of local astringents and local detergents, sequela
T49.3X5A Adverse effect of emollients, demulcents and protectants, initial encounter
T49.3X5S Adverse effect of emollients, demulcents and protectants, sequela
T49.4X5A Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, initial encounter
T49.4X5S Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, sequela
T49.5X5A Adverse effect of ophthalmological drugs and preparations, initial encounter
T49.5X5S Adverse effect of ophthalmological drugs and preparations, sequela
T49.6X5A Adverse effect of otorhinolaryngological drugs and preparations, initial encounter
T49.6X5S Adverse effect of otorhinolaryngological drugs and preparations, sequela
T49.7X5A Adverse effect of dental drugs, topically applied, initial encounter
T49.7X5S Adverse effect of dental drugs, topically applied, sequela
T49.8X5A Adverse effect of other topical agents, initial encounter
T49.8X5S Adverse effect of other topical agents, sequela
T50.0X5A Adverse effect of mineralocorticoids and their antagonists, initial encounter
T50.0X5S Adverse effect of mineralocorticoids and their antagonists, sequela
T50.1X5A Adverse effect of loop [high-ceiling] diuretics, initial encounter
T50.1X5S Adverse effect of loop [high-ceiling] diuretics, sequela
T50.2X5A Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter
T50.2X5S Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, sequela
T50.3X5A Adverse effect of electrolytic, caloric and water-balance agents, initial encounter
T50.3X5S Adverse effect of electrolytic, caloric and water-balance agents, sequela
T50.4X5A Adverse effect of drugs affecting uric acid metabolism, initial encounter
T50.4X5S Adverse effect of drugs affecting uric acid metabolism, sequela
T50.5X5A Adverse effect of appetite depressants, initial encounter
T50.5X5S Adverse effect of appetite depressants, sequela
T50.6X5A Adverse effect of antidotes and chelating agents, initial encounter
T50.6X5S Adverse effect of antidotes and chelating agents, sequela
T50.7X5A Adverse effect of analeptics and opioid receptor antagonists, initial encounter
T50.7X5S Adverse effect of analeptics and opioid receptor antagonists, sequela
T50.8X5A Adverse effect of diagnostic agents, initial encounter
T50.8X5S Adverse effect of diagnostic agents, sequela
T50.A15A Adverse effect of pertussis vaccine, including combinations with a pertussis component, initial encounter
T50.A15S Adverse effect of pertussis vaccine, including combinations with a pertussis component, sequela
T50.A25A Adverse effect of mixed bacterial vaccines without a pertussis component, initial encounter
T50.A25S Adverse effect of mixed bacterial vaccines without a pertussis component, sequela
T50.A95A Adverse effect of other bacterial vaccines, initial encounter
T50.A95S Adverse effect of other bacterial vaccines, sequela
T50.B15A Adverse effect of smallpox vaccines, initial encounter
T50.B15S Adverse effect of smallpox vaccines, sequela
T50.B95A Adverse effect of other viral vaccines, initial encounter
T50.B95S Adverse effect of other viral vaccines, sequela
T50.Z15A Adverse effect of immunoglobulin, initial encounter
T50.Z15S Adverse effect of immunoglobulin, sequela
T50.Z95A Adverse effect of other vaccines and biological substances, initial encounter
T50.Z95S Adverse effect of other vaccines and biological substances, sequela
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
T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela
T78.01XA Anaphylactic reaction due to peanuts, initial encounter
T78.01XS Anaphylactic reaction due to peanuts, sequela
T78.02XA Anaphylactic reaction due to shellfish (crustaceans), initial encounter
T78.02XS Anaphylactic reaction due to shellfish (crustaceans), sequela
T78.03XA Anaphylactic reaction due to other fish, initial encounter
T78.03XS Anaphylactic reaction due to other fish, sequela
T78.04XA Anaphylactic reaction due to fruits and vegetables, initial encounter
T78.04XS Anaphylactic reaction due to fruits and vegetables, sequela
T78.05XA Anaphylactic reaction due to tree nuts and seeds, initial encounter
T78.05XS Anaphylactic reaction due to tree nuts and seeds, sequela
T78.06XA Anaphylactic reaction due to food additives, initial encounter
T78.06XS Anaphylactic reaction due to food additives, sequela
T78.07XA Anaphylactic reaction due to milk and dairy products, initial encounter
T78.07XS Anaphylactic reaction due to milk and dairy products, sequela
T78.08XA Anaphylactic reaction due to eggs, initial encounter
T78.08XS Anaphylactic reaction due to eggs, sequela
T78.09XA Anaphylactic reaction due to other food products, initial encounter
T78.09XS Anaphylactic reaction due to other food products, sequela
T78.1XXA Other adverse food reactions, not elsewhere classified, initial encounter
T78.1XXS Other adverse food reactions, not elsewhere classified, sequela
T78.3XXA Angioneurotic edema, initial encounter
T78.3XXS Angioneurotic edema, sequela
T78.41XA Arthus phenomenon, initial encounter
T78.41XS Arthus phenomenon, sequela
T78.49XA Other allergy, initial encounter
T78.49XS Other allergy, sequela
T88.2XXA Shock due to anesthesia, initial encounter
T88.2XXS Shock due to anesthesia, sequela
T88.59XA Other complications of anesthesia, initial encounter
T88.59XS Other complications of anesthesia, sequela
T88.6XXA Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter
T88.6XXS Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, sequela

Group 3

(77 Codes)
Group 3 Paragraph

The following list of ICD-10-CM Codes will be covered for CPT Codes 95044, 95052, and 95056:

 Group 3 Codes
Code Description
E80.0 Hereditary erythropoietic porphyria
E80.1 Porphyria cutanea tarda
E80.21 Acute intermittent (hepatic) porphyria
E80.29 Other porphyria
L20.0 Besnier's prurigo
L20.81 Atopic neurodermatitis
L20.82 Flexural eczema
L20.84 Intrinsic (allergic) eczema
L20.89 Other atopic dermatitis
L23.0 Allergic contact dermatitis due to metals
L23.1 Allergic contact dermatitis due to adhesives
L23.2 Allergic contact dermatitis due to cosmetics
L23.3 Allergic contact dermatitis due to drugs in contact with skin
L23.4 Allergic contact dermatitis due to dyes
L23.5 Allergic contact dermatitis due to other chemical products
L23.6 Allergic contact dermatitis due to food in contact with the skin
L23.7 Allergic contact dermatitis due to plants, except food
L23.81 Allergic contact dermatitis due to animal (cat) (dog) dander
L23.89 Allergic contact dermatitis due to other agents
L24.0 Irritant contact dermatitis due to detergents
L24.1 Irritant contact dermatitis due to oils and greases
L24.2 Irritant contact dermatitis due to solvents
L24.3 Irritant contact dermatitis due to cosmetics
L24.4 Irritant contact dermatitis due to drugs in contact with skin
L24.5 Irritant contact dermatitis due to other chemical products
L24.6 Irritant contact dermatitis due to food in contact with skin
L24.7 Irritant contact dermatitis due to plants, except food
L24.81 Irritant contact dermatitis due to metals
L24.89 Irritant contact dermatitis due to other agents
L24.9 Irritant contact dermatitis, unspecified cause
L25.0 Unspecified contact dermatitis due to cosmetics
L25.1 Unspecified contact dermatitis due to drugs in contact with skin
L25.2 Unspecified contact dermatitis due to dyes
L25.3 Unspecified contact dermatitis due to other chemical products
L25.4 Unspecified contact dermatitis due to food in contact with skin
L25.5 Unspecified contact dermatitis due to plants, except food
L25.8 Unspecified contact dermatitis due to other agents
L25.9 Unspecified contact dermatitis, unspecified cause
L26 Exfoliative dermatitis
L30.0 Nummular dermatitis
L30.1 Dyshidrosis [pompholyx]
L30.2 Cutaneous autosensitization
L30.4 Erythema intertrigo
L30.8 Other specified dermatitis
L30.9 Dermatitis, unspecified
L50.6 Contact urticaria
L53.8 Other specified erythematous conditions
L54 Erythema in diseases classified elsewhere
L56.0 Drug phototoxic response
L56.1 Drug photoallergic response
L56.2 Photocontact dermatitis [berloque dermatitis]
L56.3 Solar urticaria
L56.4 Polymorphous light eruption
L56.8 Other specified acute skin changes due to ultraviolet radiation
L57.1 Actinic reticuloid
L57.5 Actinic granuloma
L57.8 Other skin changes due to chronic exposure to nonionizing radiation
L58.0 Acute radiodermatitis
L58.1 Chronic radiodermatitis
L59.0 Erythema ab igne [dermatitis ab igne]
L59.8 Other specified disorders of the skin and subcutaneous tissue related to radiation
L92.0 Granuloma annulare
L92.2 Granuloma faciale [eosinophilic granuloma of skin]
L95.1 Erythema elevatum diutinum
L98.2 Febrile neutrophilic dermatosis [Sweet]
T40.415A Adverse effect of fentanyl or fentanyl analogs, initial encounter
T40.415S Adverse effect of fentanyl or fentanyl analogs, sequela
T40.425A Adverse effect of tramadol, initial encounter
T40.425S Adverse effect of tramadol, sequela
T40.495A Adverse effect of other synthetic narcotics, initial encounter
T40.495S Adverse effect of other synthetic narcotics, sequela
T43.655A Adverse effect of methamphetamines, initial encounter
T43.655D Adverse effect of methamphetamines, subsequent encounter
T43.655S Adverse effect of methamphetamines, sequela
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

Group 4

(334 Codes)
Group 4 Paragraph

The following list of ICD-10-CM Codes will be covered for CPT Codes 95070, 95076, and 95079:

 Group 4 Codes
Code Description
J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
J44.89 Other specified chronic obstructive pulmonary disease
J45.20 Mild intermittent asthma, uncomplicated
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.30 Mild persistent asthma, uncomplicated
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.40 Moderate persistent asthma, uncomplicated
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.50 Severe persistent asthma, uncomplicated
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 Severe persistent asthma with status asthmaticus
J45.901 Unspecified asthma with (acute) exacerbation
J45.902 Unspecified asthma with status asthmaticus
J45.909 Unspecified asthma, uncomplicated
J45.990 Exercise induced bronchospasm
J45.991 Cough variant asthma
J45.998 Other asthma
R05.2 Subacute cough
R05.3 Chronic cough
R05.8 Other specified cough
R05.9 Cough, unspecified
R06.02 Shortness of breath
R06.2 Wheezing
T36.0X5A Adverse effect of penicillins, initial encounter
T36.0X5S Adverse effect of penicillins, sequela
T36.1X5A Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter
T36.1X5S Adverse effect of cephalosporins and other beta-lactam antibiotics, sequela
T36.2X5A Adverse effect of chloramphenicol group, initial encounter
T36.2X5S Adverse effect of chloramphenicol group, sequela
T36.3X5A Adverse effect of macrolides, initial encounter
T36.3X5S Adverse effect of macrolides, sequela
T36.4X5A Adverse effect of tetracyclines, initial encounter
T36.4X5S Adverse effect of tetracyclines, sequela
T36.5X5A Adverse effect of aminoglycosides, initial encounter
T36.5X5S Adverse effect of aminoglycosides, sequela
T36.6X5A Adverse effect of rifampicins, initial encounter
T36.6X5S Adverse effect of rifampicins, sequela
T36.7X5A Adverse effect of antifungal antibiotics, systemically used, initial encounter
T36.7X5S Adverse effect of antifungal antibiotics, systemically used, sequela
T36.8X5A Adverse effect of other systemic antibiotics, initial encounter
T36.8X5S Adverse effect of other systemic antibiotics, sequela
T37.0X5A Adverse effect of sulfonamides, initial encounter
T37.0X5S Adverse effect of sulfonamides, sequela
T37.1X5A Adverse effect of antimycobacterial drugs, initial encounter
T37.1X5S Adverse effect of antimycobacterial drugs, sequela
T37.2X5A Adverse effect of antimalarials and drugs acting on other blood protozoa, initial encounter
T37.2X5S Adverse effect of antimalarials and drugs acting on other blood protozoa, sequela
T37.3X5A Adverse effect of other antiprotozoal drugs, initial encounter
T37.3X5S Adverse effect of other antiprotozoal drugs, sequela
T37.4X5A Adverse effect of anthelminthics, initial encounter
T37.4X5S Adverse effect of anthelminthics, sequela
T37.5X5A Adverse effect of antiviral drugs, initial encounter
T37.5X5S Adverse effect of antiviral drugs, sequela
T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter
T38.0X5S Adverse effect of glucocorticoids and synthetic analogues, sequela
T38.1X5A Adverse effect of thyroid hormones and substitutes, initial encounter
T38.1X5S Adverse effect of thyroid hormones and substitutes, sequela
T38.2X5A Adverse effect of antithyroid drugs, initial encounter
T38.2X5S Adverse effect of antithyroid drugs, sequela
T38.3X5A Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter
T38.3X5S Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, sequela
T38.4X5A Adverse effect of oral contraceptives, initial encounter
T38.4X5S Adverse effect of oral contraceptives, sequela
T38.5X5A Adverse effect of other estrogens and progestogens, initial encounter
T38.5X5S Adverse effect of other estrogens and progestogens, sequela
T38.6X5A Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, initial encounter
T38.6X5S Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, sequela
T38.7X5A Adverse effect of androgens and anabolic congeners, initial encounter
T38.7X5S Adverse effect of androgens and anabolic congeners, sequela
T38.815A Adverse effect of anterior pituitary [adenohypophyseal] hormones, initial encounter
T38.815S Adverse effect of anterior pituitary [adenohypophyseal] hormones, sequela
T38.895A Adverse effect of other hormones and synthetic substitutes, initial encounter
T38.895S Adverse effect of other hormones and synthetic substitutes, sequela
T38.995A Adverse effect of other hormone antagonists, initial encounter
T38.995S Adverse effect of other hormone antagonists, sequela
T39.015A Adverse effect of aspirin, initial encounter
T39.015S Adverse effect of aspirin, sequela
T39.095A Adverse effect of salicylates, initial encounter
T39.095S Adverse effect of salicylates, sequela
T39.1X5A Adverse effect of 4-Aminophenol derivatives, initial encounter
T39.1X5S Adverse effect of 4-Aminophenol derivatives, sequela
T39.2X5A Adverse effect of pyrazolone derivatives, initial encounter
T39.2X5S Adverse effect of pyrazolone derivatives, sequela
T39.315A Adverse effect of propionic acid derivatives, initial encounter
T39.315S Adverse effect of propionic acid derivatives, sequela
T39.395A Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], initial encounter
T39.395S Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], sequela
T39.4X5A Adverse effect of antirheumatics, not elsewhere classified, initial encounter
T39.4X5S Adverse effect of antirheumatics, not elsewhere classified, sequela
T39.8X5A Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, initial encounter
T39.8X5S Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, sequela
T40.0X5A Adverse effect of opium, initial encounter
T40.0X5S Adverse effect of opium, sequela
T40.2X5A Adverse effect of other opioids, initial encounter
T40.2X5S Adverse effect of other opioids, sequela
T40.3X5A Adverse effect of methadone, initial encounter
T40.3X5S Adverse effect of methadone, sequela
T40.415A Adverse effect of fentanyl or fentanyl analogs, initial encounter
T40.415S Adverse effect of fentanyl or fentanyl analogs, sequela
T40.425A Adverse effect of tramadol, initial encounter
T40.425S Adverse effect of tramadol, sequela
T40.495A Adverse effect of other synthetic narcotics, initial encounter
T40.495S Adverse effect of other synthetic narcotics, sequela
T40.5X5A Adverse effect of cocaine, initial encounter
T40.5X5S Adverse effect of cocaine, sequela
T40.695A Adverse effect of other narcotics, initial encounter
T40.695S Adverse effect of other narcotics, sequela
T40.995A Adverse effect of other psychodysleptics [hallucinogens], initial encounter
T40.995S Adverse effect of other psychodysleptics [hallucinogens], sequela
T41.0X5A Adverse effect of inhaled anesthetics, initial encounter
T41.0X5S Adverse effect of inhaled anesthetics, sequela
T41.1X5A Adverse effect of intravenous anesthetics, initial encounter
T41.1X5S Adverse effect of intravenous anesthetics, sequela
T41.295A Adverse effect of other general anesthetics, initial encounter
T41.295S Adverse effect of other general anesthetics, sequela
T41.3X5A Adverse effect of local anesthetics, initial encounter
T41.3X5S Adverse effect of local anesthetics, sequela
T41.5X5A Adverse effect of therapeutic gases, initial encounter
T41.5X5S Adverse effect of therapeutic gases, sequela
T42.0X5A Adverse effect of hydantoin derivatives, initial encounter
T42.0X5S Adverse effect of hydantoin derivatives, sequela
T42.1X5A Adverse effect of iminostilbenes, initial encounter
T42.1X5S Adverse effect of iminostilbenes, sequela
T42.2X5A Adverse effect of succinimides and oxazolidinediones, initial encounter
T42.2X5S Adverse effect of succinimides and oxazolidinediones, sequela
T42.3X5A Adverse effect of barbiturates, initial encounter
T42.3X5S Adverse effect of barbiturates, sequela
T42.4X5A Adverse effect of benzodiazepines, initial encounter
T42.4X5S Adverse effect of benzodiazepines, sequela
T42.5X5A Adverse effect of mixed antiepileptics, initial encounter
T42.5X5S Adverse effect of mixed antiepileptics, sequela
T42.6X5A Adverse effect of other antiepileptic and sedative-hypnotic drugs, initial encounter
T42.6X5S Adverse effect of other antiepileptic and sedative-hypnotic drugs, sequela
T42.8X5A Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, initial encounter
T42.8X5S Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, sequela
T43.015A Adverse effect of tricyclic antidepressants, initial encounter
T43.015S Adverse effect of tricyclic antidepressants, sequela
T43.025A Adverse effect of tetracyclic antidepressants, initial encounter
T43.025S Adverse effect of tetracyclic antidepressants, sequela
T43.1X5A Adverse effect of monoamine-oxidase-inhibitor antidepressants, initial encounter
T43.1X5S Adverse effect of monoamine-oxidase-inhibitor antidepressants, sequela
T43.215A Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, initial encounter
T43.215S Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, sequela
T43.225A Adverse effect of selective serotonin reuptake inhibitors, initial encounter
T43.225S Adverse effect of selective serotonin reuptake inhibitors, sequela
T43.295A Adverse effect of other antidepressants, initial encounter
T43.295S Adverse effect of other antidepressants, sequela
T43.3X5A Adverse effect of phenothiazine antipsychotics and neuroleptics, initial encounter
T43.3X5S Adverse effect of phenothiazine antipsychotics and neuroleptics, sequela
T43.4X5A Adverse effect of butyrophenone and thiothixene neuroleptics, initial encounter
T43.4X5S Adverse effect of butyrophenone and thiothixene neuroleptics, sequela
T43.595A Adverse effect of other antipsychotics and neuroleptics, initial encounter
T43.595S Adverse effect of other antipsychotics and neuroleptics, sequela
T43.615A Adverse effect of caffeine, initial encounter
T43.615S Adverse effect of caffeine, sequela
T43.625A Adverse effect of amphetamines, initial encounter
T43.625S Adverse effect of amphetamines, sequela
T43.635A Adverse effect of methylphenidate, initial encounter
T43.635S Adverse effect of methylphenidate, sequela
T43.655A Adverse effect of methamphetamines, initial encounter
T43.655D Adverse effect of methamphetamines, subsequent encounter
T43.655S Adverse effect of methamphetamines, sequela
T43.695A Adverse effect of other psychostimulants, initial encounter
T43.695S Adverse effect of other psychostimulants, sequela
T43.8X5A Adverse effect of other psychotropic drugs, initial encounter
T43.8X5S Adverse effect of other psychotropic drugs, sequela
T44.0X5A Adverse effect of anticholinesterase agents, initial encounter
T44.0X5S Adverse effect of anticholinesterase agents, sequela
T44.1X5A Adverse effect of other parasympathomimetics [cholinergics], initial encounter
T44.1X5S Adverse effect of other parasympathomimetics [cholinergics], sequela
T44.2X5A Adverse effect of ganglionic blocking drugs, initial encounter
T44.2X5S Adverse effect of ganglionic blocking drugs, sequela
T44.3X5A Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, initial encounter
T44.3X5S Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, sequela
T44.4X5A Adverse effect of predominantly alpha-adrenoreceptor agonists, initial encounter
T44.4X5S Adverse effect of predominantly alpha-adrenoreceptor agonists, sequela
T44.5X5A Adverse effect of predominantly beta-adrenoreceptor agonists, initial encounter
T44.5X5S Adverse effect of predominantly beta-adrenoreceptor agonists, sequela
T44.6X5A Adverse effect of alpha-adrenoreceptor antagonists, initial encounter
T44.6X5S Adverse effect of alpha-adrenoreceptor antagonists, sequela
T44.7X5A Adverse effect of beta-adrenoreceptor antagonists, initial encounter
T44.7X5S Adverse effect of beta-adrenoreceptor antagonists, sequela
T44.8X5A Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, initial encounter
T44.8X5S Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, sequela
T44.995A Adverse effect of other drug primarily affecting the autonomic nervous system, initial encounter
T44.995S Adverse effect of other drug primarily affecting the autonomic nervous system, sequela
T45.0X5A Adverse effect of antiallergic and antiemetic drugs, initial encounter
T45.0X5S Adverse effect of antiallergic and antiemetic drugs, sequela
T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
T45.1X5S Adverse effect of antineoplastic and immunosuppressive drugs, sequela
T45.2X5A Adverse effect of vitamins, initial encounter
T45.2X5S Adverse effect of vitamins, sequela
T45.3X5A Adverse effect of enzymes, initial encounter
T45.3X5S Adverse effect of enzymes, sequela
T45.4X5A Adverse effect of iron and its compounds, initial encounter
T45.4X5S Adverse effect of iron and its compounds, sequela
T45.515A Adverse effect of anticoagulants, initial encounter
T45.515S Adverse effect of anticoagulants, sequela
T45.525A Adverse effect of antithrombotic drugs, initial encounter
T45.525S Adverse effect of antithrombotic drugs, sequela
T45.615A Adverse effect of thrombolytic drugs, initial encounter
T45.615S Adverse effect of thrombolytic drugs, sequela
T45.625A Adverse effect of hemostatic drug, initial encounter
T45.625S Adverse effect of hemostatic drug, sequela
T45.695A Adverse effect of other fibrinolysis-affecting drugs, initial encounter
T45.695S Adverse effect of other fibrinolysis-affecting drugs, sequela
T45.7X5A Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, initial encounter
T45.7X5S Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, sequela
T45.8X5A Adverse effect of other primarily systemic and hematological agents, initial encounter
T45.8X5S Adverse effect of other primarily systemic and hematological agents, sequela
T46.0X5A Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter
T46.0X5S Adverse effect of cardiac-stimulant glycosides and drugs of similar action, sequela
T46.1X5A Adverse effect of calcium-channel blockers, initial encounter
T46.1X5S Adverse effect of calcium-channel blockers, sequela
T46.2X5A Adverse effect of other antidysrhythmic drugs, initial encounter
T46.2X5S Adverse effect of other antidysrhythmic drugs, sequela
T46.3X5A Adverse effect of coronary vasodilators, initial encounter
T46.3X5S Adverse effect of coronary vasodilators, sequela
T46.4X5A Adverse effect of angiotensin-converting-enzyme inhibitors, initial encounter
T46.4X5S Adverse effect of angiotensin-converting-enzyme inhibitors, sequela
T46.5X5A Adverse effect of other antihypertensive drugs, initial encounter
T46.5X5S Adverse effect of other antihypertensive drugs, sequela
T46.6X5A Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter
T46.6X5S Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, sequela
T46.7X5A Adverse effect of peripheral vasodilators, initial encounter
T46.7X5S Adverse effect of peripheral vasodilators, sequela
T46.8X5A Adverse effect of antivaricose drugs, including sclerosing agents, initial encounter
T46.8X5S Adverse effect of antivaricose drugs, including sclerosing agents, sequela
T46.995A Adverse effect of other agents primarily affecting the cardiovascular system, initial encounter
T46.995S Adverse effect of other agents primarily affecting the cardiovascular system, sequela
T47.0X5A Adverse effect of histamine H2-receptor blockers, initial encounter
T47.0X5S Adverse effect of histamine H2-receptor blockers, sequela
T47.1X5A Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter
T47.1X5S Adverse effect of other antacids and anti-gastric-secretion drugs, sequela
T47.2X5A Adverse effect of stimulant laxatives, initial encounter
T47.2X5S Adverse effect of stimulant laxatives, sequela
T47.3X5A Adverse effect of saline and osmotic laxatives, initial encounter
T47.3X5S Adverse effect of saline and osmotic laxatives, sequela
T47.4X5A Adverse effect of other laxatives, initial encounter
T47.4X5S Adverse effect of other laxatives, sequela
T47.5X5A Adverse effect of digestants, initial encounter
T47.5X5S Adverse effect of digestants, sequela
T47.6X5A Adverse effect of antidiarrheal drugs, initial encounter
T47.6X5S Adverse effect of antidiarrheal drugs, sequela
T47.7X5A Adverse effect of emetics, initial encounter
T47.7X5S Adverse effect of emetics, sequela
T47.8X5A Adverse effect of other agents primarily affecting gastrointestinal system, initial encounter
T47.8X5S Adverse effect of other agents primarily affecting gastrointestinal system, sequela
T48.0X5A Adverse effect of oxytocic drugs, initial encounter
T48.0X5S Adverse effect of oxytocic drugs, sequela
T48.1X5A Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], initial encounter
T48.1X5S Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], sequela
T48.295A Adverse effect of other drugs acting on muscles, initial encounter
T48.295S Adverse effect of other drugs acting on muscles, sequela
T48.3X5A Adverse effect of antitussives, initial encounter
T48.3X5S Adverse effect of antitussives, sequela
T48.4X5A Adverse effect of expectorants, initial encounter
T48.4X5S Adverse effect of expectorants, sequela
T48.5X5A Adverse effect of other anti-common-cold drugs, initial encounter
T48.5X5S Adverse effect of other anti-common-cold drugs, sequela
T48.6X5A Adverse effect of antiasthmatics, initial encounter
T48.6X5S Adverse effect of antiasthmatics, sequela
T48.995A Adverse effect of other agents primarily acting on the respiratory system, initial encounter
T48.995S Adverse effect of other agents primarily acting on the respiratory system, sequela
T49.0X5A Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, initial encounter
T49.0X5S Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, sequela
T49.1X5A Adverse effect of antipruritics, initial encounter
T49.1X5S Adverse effect of antipruritics, sequela
T49.2X5A Adverse effect of local astringents and local detergents, initial encounter
T49.2X5S Adverse effect of local astringents and local detergents, sequela
T49.3X5A Adverse effect of emollients, demulcents and protectants, initial encounter
T49.3X5S Adverse effect of emollients, demulcents and protectants, sequela
T49.4X5A Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, initial encounter
T49.4X5S Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, sequela
T49.5X5A Adverse effect of ophthalmological drugs and preparations, initial encounter
T49.5X5S Adverse effect of ophthalmological drugs and preparations, sequela
T49.6X5A Adverse effect of otorhinolaryngological drugs and preparations, initial encounter
T49.6X5S Adverse effect of otorhinolaryngological drugs and preparations, sequela
T49.7X5A Adverse effect of dental drugs, topically applied, initial encounter
T49.7X5S Adverse effect of dental drugs, topically applied, sequela
T49.8X5A Adverse effect of other topical agents, initial encounter
T49.8X5S Adverse effect of other topical agents, sequela
T50.0X5A Adverse effect of mineralocorticoids and their antagonists, initial encounter
T50.0X5S Adverse effect of mineralocorticoids and their antagonists, sequela
T50.1X5A Adverse effect of loop [high-ceiling] diuretics, initial encounter
T50.1X5S Adverse effect of loop [high-ceiling] diuretics, sequela
T50.2X5A Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter
T50.2X5S Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, sequela
T50.3X5A Adverse effect of electrolytic, caloric and water-balance agents, initial encounter
T50.3X5S Adverse effect of electrolytic, caloric and water-balance agents, sequela
T50.4X5A Adverse effect of drugs affecting uric acid metabolism, initial encounter
T50.4X5S Adverse effect of drugs affecting uric acid metabolism, sequela
T50.5X5A Adverse effect of appetite depressants, initial encounter
T50.5X5S Adverse effect of appetite depressants, sequela
T50.6X5A Adverse effect of antidotes and chelating agents, initial encounter
T50.6X5S Adverse effect of antidotes and chelating agents, sequela
T50.7X5A Adverse effect of analeptics and opioid receptor antagonists, initial encounter
T50.7X5S Adverse effect of analeptics and opioid receptor antagonists, sequela
T50.8X5A Adverse effect of diagnostic agents, initial encounter
T50.8X5S Adverse effect of diagnostic agents, sequela
T50.A15A Adverse effect of pertussis vaccine, including combinations with a pertussis component, initial encounter
T50.A15S Adverse effect of pertussis vaccine, including combinations with a pertussis component, sequela
T50.A25A Adverse effect of mixed bacterial vaccines without a pertussis component, initial encounter
T50.A25S Adverse effect of mixed bacterial vaccines without a pertussis component, sequela
T50.A95A Adverse effect of other bacterial vaccines, initial encounter
T50.A95S Adverse effect of other bacterial vaccines, sequela
T50.B15A Adverse effect of smallpox vaccines, initial encounter
T50.B15S Adverse effect of smallpox vaccines, sequela
T50.B95A Adverse effect of other viral vaccines, initial encounter
T50.B95S Adverse effect of other viral vaccines, sequela
T50.Z15A Adverse effect of immunoglobulin, initial encounter
T50.Z15S Adverse effect of immunoglobulin, sequela
T50.Z95A Adverse effect of other vaccines and biological substances, initial encounter
T50.Z95S Adverse effect of other vaccines and biological substances, sequela
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
T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela
T78.3XXA Angioneurotic edema, initial encounter
T78.3XXS Angioneurotic edema, sequela
T78.41XA Arthus phenomenon, initial encounter
T78.41XS Arthus phenomenon, sequela
T78.49XA Other allergy, initial encounter
T78.49XS Other allergy, sequela
T88.2XXA Shock due to anesthesia, initial encounter
T88.2XXS Shock due to anesthesia, sequela
T88.59XA Other complications of anesthesia, initial encounter
T88.59XS Other complications of anesthesia, sequela
T88.6XXA Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter
T88.6XXS Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, sequela
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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Group 1

Group 1 Paragraph

All ICD-10-CM Codes not listed under the ICD-10-CM Codes That Support Medical Necessity section of this policy will be denied.

 Group 1 Codes

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ICD-10-PCS Codes

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Group 1

Group 1 Paragraph

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 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
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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.

Code Description
99999 Not Applicable
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Other Coding Information

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Group 1

Group 1 Paragraph

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 Group 1 Codes

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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
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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
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
04/01/2024 R7

Per 2024 CPT/HCPCS Updates:

Either the short and/or long code description was changed for the following code(s). Please note. Depending on which descriptor was used, there may not be any changes to the code display in this document:

95024

This update is effective 04/01/2024.
10/01/2023 R6

Updated to indicate this article is an LCD Reference Article.
10/01/2023 R5

Per Annual ICD-10 Updates:

The following codes were added to Group 2 and 4: J44.89
10/01/2022 R4

Under ICD-10 Codes that Support Medical Necessity Groups I/II/III/IV:  Added Codes: T43.655A, T43.655D, T43.655S

This revision is due to the Annual ICD-10 coding update and is effective 10/01/2022.
10/01/2021 R3

ICD-10 Codes that support Medical Necessity Groups I/II/IV: Deleted Codes R05; T40.7X5A; T40.7X5S

ICD-10 Codes that support Medical Necessity Groups II/IV: Added Codes: R05.2; R05.3; R05.8; R05.9

This revision is due to the Annual ICD-10 coding update and is effective 10/01/2021

 

 
01/01/2021 R2

Under CPT/HCPCS Codes Group 1:

Deleted Codes: 95071

This revision is due to the Q1 2021 CPT/HCPCS Code Update and is effective for dates of service on or after 01/01/2021.
10/01/2020 R1

10/01/2020: Under ICD-10 Codes that Support Medical Necessity Grops I/II/III/IV

Added T40.415A; T40.415S;T40.425A;T40.425S; T40.495A; T40.495S.

Deleted from Group I: T40.4X5A; T40.4X5S

Deleted from Group II: T40.4X5A; T40.4X5S

Deleted from Group IV: T40.4X5A; T40.4X5S

These revisions are due to the Annual ICD-10 Updates and become effective 10/01/2020
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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
L34313 - Allergy Testing
Related National Coverage Documents
NCDs
110.11 - Food Allergy Testing and Treatment
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
04/17/2024 04/25/2024 - N/A Currently in Effect View
03/25/2024 04/01/2024 - 04/24/2024 Superseded You are here
11/22/2023 10/01/2023 - 03/31/2024 Superseded View
08/24/2023 10/01/2023 - N/A Superseded View
08/16/2022 10/01/2022 - 09/30/2023 Superseded View
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