CodeMap®  150 North Wacker Drive
Suite 1870
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax
customerservice@codemap.com
      


User Information

Create New Account

Lost Password

Username:
Password:


Quick Links

PLA Codes

Laboratory Fee Schedule

2019
2018

Physician Fee Schedule

2019
2018

OPPS Fee Schedule

2019
2018

ASC Fee Schedule

2019
2018

APC Codes

2019
2018

DRG Codes

2019
2018

ASP Drug Pricing Files

January 2019
October 2018


CMS Transmittals



National Coverage Determination
Procedure Code: 83036
Glycated Hemoglobin/Glycated Protein
CMS Policy Number: 190.21
Back to NCD List

Description: The management of diabetes mellitus requires regular determinations of blood glucose levels. Glycated hemoglobin/protein levels are used to assess long-term glucose control in diabetes. Alternative names for these tests include glycated or glycosylated hemoglobin or Hgb, hemoglobin glycated or glycosylated protein, and fructosamine.

Glycated hemoglobin (equivalent to hemoglobin A1) refers to total glycosylated hemoglobin present in erythrocytes, usually determined by affinity or ion-exchange chromatographic methodology. Hemoglobin A1c refers to the major component of hemoglobin A1, usually determined by ion-exchange affinity chromatography, immunoassay or agar gel electrophoresis. Fructosamine or glycated protein refers to glycosylated protein present in a serum or plasma sample. Glycated protein refers to measurement of the component of the specific protein that is glycated usually by colorimetric method or affinity chromatography.

Glycated hemoglobin in whole blood assesses glycemic control over a period of 4-8 weeks and appears to be the more appropriate test for monitoring a patient who is capable of maintaining long-term, stable control. Measurement may be medically necessary every 3 months to determine whether a patient’s metabolic control has been on average within the target range. More frequent assessments, every 1-2 months, may be appropriate in the patient whose diabetes regimen has been altered to improve control or in whom evidence is present that intercurrent events may have altered a previously satisfactory level of control (for example, post- major surgery or as a result of glucocorticoid therapy). Glycated protein in serum/plasma assesses glycemic control over a period of 1-2 weeks. It may be reasonable and necessary to monitor glycated protein monthly in pregnant diabetic women. Glycated hemoglobin/protein test results may be low, indicating significant, persistent hypoglycemia, in nesidioblastosis or insulinoma, conditions which are accompanied by inappropriate hyperinsulinemia. A below normal test value is helpful in establishing the patient’s hypoglycemic state in those conditions.

Indications:
Glycated hemoglobin/protein testing is accepted as medically necessary for management and control of diabetes and to assess hyperglycemia, a history of hyperglycemia or dangerous hypoglycemia. Glycated protein testing may be used in place of glycated hemoglobin in the management of diabetic patients, and is useful in patients with abnormalities of erythrocytes such as hemolytic anemia or hemoglobinopathies.

Limitations:
It is not reasonable and necessary to perform glycated hemoglobin tests more often than every three months on a controlled diabetic patient to determine if the patient’s metabolic control has been on average within the target range. It is not reasonable and necessary for these tests to be performed more frequently than once a month for diabetic pregnant women. Testing for uncontrolled type one or two diabetes mellitus may require testing more than four times a year. The above Description Section provides the clinical basis for those situations in which testing more frequently than four times per annum is indicated, and medical necessity documentation must support such testing in excess of the above guidelines.

Many analytical methods of glycated hemoglobin show interference from elevated levels of fetal hemoglobin or by variant hemoglobin molecules. When the glycated hemoglobin assay is initially performed in these patients, the laboratory may inform the ordering physician of a possible analytical interference. Alternative testing, including glycated protein, for example, fructosamine, may be indicated for monitoring the degree of glycemic control. It is therefore conceivable that a patient will have both a glycated hemoglobin and glycated protein ordered on the same day. This should be limited to the initial assay of glycated hemoglobin, with subsequent exclusive use of glycated protein. These tests are not considered to be medically necessary for the diagnosis of diabetes.



To review all requirements of this policy, please see: CMS NCD listing by Chapter

Covered ICD-10 Codes.

ICD-10Descriptor
D13.7 Benign neoplasm of endocrine pancreas
E08.00 Diab d/t undrl cond w hyprosm w/o nonket hyprgly-hypros coma
E08.01 Diabetes due to underlying condition w hyprosm w coma
E08.10 Diabetes due to underlying condition w ketoacidosis w/o coma
E08.11 Diabetes due to underlying condition w ketoacidosis w coma
E08.21 Diabetes due to underlying condition w diabetic nephropathy
E08.22 Diabetes due to undrl cond w diabetic chronic kidney disease
E08.29 Diabetes due to undrl condition w oth diabetic kidney comp
E08.311 Diab due to undrl cond w unsp diabetic rtnop w macular edema
E08.319 Diab due to undrl cond w unsp diab rtnop w/o macular edema
E08.3211 Diabetes with mild nonp rtnop with macular edema, right eye
E08.3212 Diabetes with mild nonp rtnop with macular edema, left eye
E08.3213 Diabetes with mild nonp rtnop with macular edema, bilateral
E08.3291 Diabetes with mild nonp rtnop without macular edema, r eye
E08.3292 Diab with mild nonp rtnop without macular edema, left eye
E08.3293 Diabetes with mild nonp rtnop without macular edema, bi
E08.3311 Diabetes with moderate nonp rtnop with macular edema, r eye
E08.3312 Diab with moderate nonp rtnop with macular edema, left eye
E08.3313 Diabetes with moderate nonp rtnop with macular edema, bi
E08.3391 Diab with moderate nonp rtnop without macular edema, r eye
E08.3392 Diab with moderate nonp rtnop without macular edema, l eye
E08.3393 Diabetes with moderate nonp rtnop without macular edema, bi
E08.3411 Diabetes with severe nonp rtnop with macular edema, r eye
E08.3412 Diabetes with severe nonp rtnop with macular edema, left eye
E08.3413 Diabetes with severe nonp rtnop with macular edema, bi
E08.3491 Diabetes with severe nonp rtnop without macular edema, r eye
E08.3492 Diab with severe nonp rtnop without macular edema, left eye
E08.3493 Diabetes with severe nonp rtnop without macular edema, bi
E08.3511 Diab with prolif diabetic rtnop with macular edema, r eye
E08.3512 Diab with prolif diabetic rtnop with macular edema, left eye
E08.3513 Diabetes with prolif diabetic rtnop with macular edema, bi
E08.3521 Diab with prolif diab rtnop with trctn dtch macula, r eye
E08.3522 Diab with prolif diab rtnop with trctn dtch macula, left eye
E08.3523 Diab with prolif diabetic rtnop with trctn dtch macula, bi
E08.3531 Diab with prolif diab rtnop with trctn dtch n-mcla, r eye
E08.3532 Diab with prolif diab rtnop with trctn dtch n-mcla, left eye
E08.3533 Diab with prolif diabetic rtnop with trctn dtch n-mcla, bi
E08.3541 Diabetes with prolif diabetic rtnop with comb detach, r eye
E08.3542 Diab with prolif diabetic rtnop with comb detach, left eye
E08.3543 Diabetes with prolif diabetic rtnop with combined detach, bi
E08.3551 Diabetes with stable prolif diabetic retinopathy, right eye
E08.3552 Diabetes with stable prolif diabetic retinopathy, left eye
E08.3553 Diabetes with stable prolif diabetic retinopathy, bilateral
E08.3591 Diab with prolif diabetic rtnop without macular edema, r eye
E08.3592 Diab with prolif diab rtnop without macular edema, left eye
E08.3593 Diab with prolif diabetic rtnop without macular edema, bi
E08.36 Diabetes due to underlying condition w diabetic cataract
E08.37X1 Diab with diabetic macular edema, resolved fol trtmt, r eye
E08.37X2 Diab with diab macular edema, resolved fol trtmt, left eye
E08.37X3 Diabetes with diabetic macular edema, resolved fol trtmt, bi
E08.39 Diabetes due to undrl condition w oth diabetic opth comp
E08.40 Diabetes due to underlying condition w diabetic neurop, unsp
E08.41 Diabetes due to undrl condition w diabetic mononeuropathy
E08.42 Diabetes due to underlying condition w diabetic polyneurop
E08.43 Diab due to undrl cond w diabetic autonm (poly)neuropathy
E08.44 Diabetes due to underlying condition w diabetic amyotrophy
E08.49 Diabetes due to undrl condition w oth diabetic neuro comp
E08.51 Diab due to undrl cond w diab prph angiopath w/o gangrene
E08.52 Diab due to undrl cond w diabetic prph angiopath w gangrene
E08.59 Diabetes due to underlying condition w oth circulatory comp
E08.610 Diabetes due to undrl cond w diabetic neuropathic arthrop
E08.618 Diabetes due to underlying condition w oth diabetic arthrop
E08.620 Diabetes due to underlying condition w diabetic dermatitis
E08.621 Diabetes mellitus due to underlying condition w foot ulcer
E08.622 Diabetes due to underlying condition w oth skin ulcer
E08.628 Diabetes due to underlying condition w oth skin comp
E08.630 Diabetes due to underlying condition w periodontal disease
E08.638 Diabetes due to underlying condition w oth oral comp
E08.641 Diabetes due to underlying condition w hypoglycemia w coma
E08.649 Diabetes due to underlying condition w hypoglycemia w/o coma
E08.65 Diabetes due to underlying condition w hyperglycemia
E08.69 Diabetes due to underlying condition w oth complication
E08.8 Diabetes due to underlying condition w unsp complications
E08.9 Diabetes due to underlying condition w/o complications
E09.00 Drug/chem diab w hyprosm w/o nonket hyprgly-hypros coma
E09.01 Drug/chem diabetes mellitus w hyperosmolarity w coma
E09.10 Drug/chem diabetes mellitus w ketoacidosis w/o coma
E09.11 Drug/chem diabetes mellitus w ketoacidosis w coma
E09.21 Drug/chem diabetes mellitus w diabetic nephropathy
E09.22 Drug/chem diabetes w diabetic chronic kidney disease
E09.29 Drug/chem diabetes w oth diabetic kidney complication
E09.311 Drug/chem diabetes w unsp diabetic rtnop w macular edema
E09.319 Drug/chem diabetes w unsp diabetic rtnop w/o macular edema
E09.3211 Drug/chem diab with mild nonp rtnop with mclr edema, r eye
E09.3212 Drug/chem diab with mild nonp rtnop with mclr edema, l eye
E09.3213 Drug/chem diab with mild nonp rtnop with macular edema, bi
E09.3291 Drug/chem diab with mild nonp rtnop w/o mclr edema, r eye
E09.3292 Drug/chem diab with mild nonp rtnop w/o mclr edema, l eye
E09.3293 Drug/chem diab with mild nonp rtnop without mclr edema, bi
E09.3311 Drug/chem diab with mod nonp rtnop with macular edema, r eye
E09.3312 Drug/chem diab with mod nonp rtnop with macular edema, l eye
E09.3313 Drug/chem diab with mod nonp rtnop with macular edema, bi
E09.3391 Drug/chem diab with mod nonp rtnop without mclr edema, r eye
E09.3392 Drug/chem diab with mod nonp rtnop without mclr edema, l eye
E09.3393 Drug/chem diab with mod nonp rtnop without macular edema, bi
E09.3411 Drug/chem diab with severe nonp rtnop with mclr edema, r eye
E09.3412 Drug/chem diab with severe nonp rtnop with mclr edema, l eye
E09.3413 Drug/chem diab with severe nonp rtnop with macular edema, bi
E09.3491 Drug/chem diab with severe nonp rtnop w/o mclr edema, r eye
E09.3492 Drug/chem diab with severe nonp rtnop w/o mclr edema, l eye
E09.3493 Drug/chem diab with severe nonp rtnop without mclr edema, bi
E09.3511 Drug/chem diab with prolif diab rtnop with mclr edema, r eye
E09.3512 Drug/chem diab with prolif diab rtnop with mclr edema, l eye
E09.3513 Drug/chem diab with prolif diab rtnop with macular edema, bi
E09.3521 Drug/chem diab w prolif diab rtnop w trctn dtch macula,r eye
E09.3522 Drug/chem diab w prolif diab rtnop w trctn dtch macula,l eye
E09.3523 Drug/chem diab w prolif diab rtnop w trctn dtch macula, bi
E09.3531 Drug/chem diab w prolif diab rtnop w trctn dtch n-mcla,r eye
E09.3532 Drug/chem diab w prolif diab rtnop w trctn dtch n-mcla,l eye
E09.3533 Drug/chem diab w prolif diab rtnop w trctn dtch n-mcla, bi
E09.3541 Drug/chem diab w prolif diab rtnop with comb detach, r eye
E09.3542 Drug/chem diab w prolif diab rtnop with comb detach, l eye
E09.3543 Drug/chem diab with prolif diab rtnop with comb detach, bi
E09.3551 Drug/chem diabetes with stable prolif diabetic rtnop, r eye
E09.3552 Drug/chem diab with stable prolif diabetic rtnop, left eye
E09.3553 Drug/chem diabetes with stable prolif diabetic rtnop, bi
E09.3591 Drug/chem diab with prolif diab rtnop w/o mclr edema, r eye
E09.3592 Drug/chem diab with prolif diab rtnop w/o mclr edema, l eye
E09.3593 Drug/chem diab with prolif diab rtnop without mclr edema, bi
E09.36 Drug/chem diabetes mellitus w diabetic cataract
E09.37X1 Drug/chem diab w diab mclr edma, resolved fol trtmt, r eye
E09.37X2 Drug/chem diab w diab mclr edma, resolved fol trtmt, l eye
E09.37X3 Drug/chem diab with diab mclr edema, resolved fol trtmt, bi
E09.39 Drug/chem diabetes w oth diabetic ophthalmic complication
E09.40 Drug/chem diabetes w neuro comp w diabetic neuropathy, unsp
E09.41 Drug/chem diabetes w neuro comp w diabetic mononeuropathy
E09.42 Drug/chem diabetes w neurological comp w diabetic polyneurop
E09.43 Drug/chem diab w neuro comp w diab autonm (poly)neuropathy
E09.44 Drug/chem diabetes w neurological comp w diabetic amyotrophy
E09.49 Drug/chem diabetes w neuro comp w oth diabetic neuro comp
E09.51 Drug/chem diabetes w diabetic prph angiopath w/o gangrene
E09.52 Drug/chem diabetes w diabetic prph angiopath w gangrene
E09.59 Drug/chem diabetes mellitus w oth circulatory complications
E09.610 Drug/chem diabetes w diabetic neuropathic arthropathy
E09.618 Drug/chem diabetes mellitus w oth diabetic arthropathy
E09.620 Drug/chem diabetes mellitus w diabetic dermatitis
E09.621 Drug or chemical induced diabetes mellitus with foot ulcer
E09.622 Drug or chemical induced diabetes mellitus w oth skin ulcer
E09.628 Drug/chem diabetes mellitus w oth skin complications
E09.630 Drug/chem diabetes mellitus w periodontal disease
E09.638 Drug/chem diabetes mellitus w oth oral complications
E09.641 Drug/chem diabetes mellitus w hypoglycemia w coma
E09.649 Drug/chem diabetes mellitus w hypoglycemia w/o coma
E09.65 Drug or chemical induced diabetes mellitus w hyperglycemia
E09.69 Drug/chem diabetes mellitus w oth complication
E09.8 Drug/chem diabetes mellitus w unsp complications
E09.9 Drug or chemical induced diabetes mellitus w/o complications
E10.10 Type 1 diabetes mellitus with ketoacidosis without coma
E10.11 Type 1 diabetes mellitus with ketoacidosis with coma
E10.21 Type 1 diabetes mellitus with diabetic nephropathy
E10.22 Type 1 diabetes mellitus w diabetic chronic kidney disease
E10.29 Type 1 diabetes mellitus w oth diabetic kidney complication
E10.311 Type 1 diabetes w unsp diabetic retinopathy w macular edema
E10.319 Type 1 diabetes w unsp diabetic rtnop w/o macular edema
E10.3211 Type 1 diab with mild nonp rtnop with macular edema, r eye
E10.3212 Type 1 diab with mild nonp rtnop with macular edema, l eye
E10.3213 Type 1 diabetes with mild nonp rtnop with macular edema, bi
E10.3291 Type 1 diab with mild nonp rtnop without mclr edema, r eye
E10.3292 Type 1 diab with mild nonp rtnop without mclr edema, l eye
E10.3293 Type 1 diab with mild nonp rtnop without macular edema, bi
E10.3311 Type 1 diab with mod nonp rtnop with macular edema, r eye
E10.3312 Type 1 diab with mod nonp rtnop with macular edema, l eye
E10.3313 Type 1 diab with moderate nonp rtnop with macular edema, bi
E10.3391 Type 1 diab with mod nonp rtnop without macular edema, r eye
E10.3392 Type 1 diab with mod nonp rtnop without macular edema, l eye
E10.3393 Type 1 diab with mod nonp rtnop without macular edema, bi
E10.3411 Type 1 diab with severe nonp rtnop with macular edema, r eye
E10.3412 Type 1 diab with severe nonp rtnop with macular edema, l eye
E10.3413 Type 1 diab with severe nonp rtnop with macular edema, bi
E10.3491 Type 1 diab with severe nonp rtnop without mclr edema, r eye
E10.3492 Type 1 diab with severe nonp rtnop without mclr edema, l eye
E10.3493 Type 1 diab with severe nonp rtnop without macular edema, bi
E10.3511 Type 1 diab with prolif diab rtnop with macular edema, r eye
E10.3512 Type 1 diab with prolif diab rtnop with macular edema, l eye
E10.3513 Type 1 diab with prolif diab rtnop with macular edema, bi
E10.3521 Type 1 diab w prolif diab rtnop w trctn dtch macula, r eye
E10.3522 Type 1 diab w prolif diab rtnop w trctn dtch macula, l eye
E10.3523 Type 1 diab w prolif diab rtnop with trctn dtch macula, bi
E10.3531 Type 1 diab w prolif diab rtnop w trctn dtch n-mcla, r eye
E10.3532 Type 1 diab w prolif diab rtnop w trctn dtch n-mcla, l eye
E10.3533 Type 1 diab w prolif diab rtnop with trctn dtch n-mcla, bi
E10.3541 Type 1 diab with prolif diab rtnop with comb detach, r eye
E10.3542 Type 1 diab with prolif diab rtnop with comb detach, l eye
E10.3543 Type 1 diab with prolif diabetic rtnop with comb detach, bi
E10.3551 Type 1 diabetes with stable prolif diabetic rtnop, right eye
E10.3552 Type 1 diabetes with stable prolif diabetic rtnop, left eye
E10.3553 Type 1 diabetes with stable prolif diabetic rtnop, bilateral
E10.3591 Type 1 diab with prolif diab rtnop without mclr edema, r eye
E10.3592 Type 1 diab with prolif diab rtnop without mclr edema, l eye
E10.3593 Type 1 diab with prolif diab rtnop without macular edema, bi
E10.36 Type 1 diabetes mellitus with diabetic cataract
E10.37X1 Type 1 diab with diab mclr edema, resolved fol trtmt, r eye
E10.37X2 Type 1 diab with diab mclr edema, resolved fol trtmt, l eye
E10.37X3 Type 1 diab with diab macular edema, resolved fol trtmt, bi
E10.39 Type 1 diabetes w oth diabetic ophthalmic complication
E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unsp
E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy
E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy
E10.43 Type 1 diabetes w diabetic autonomic (poly)neuropathy
E10.44 Type 1 diabetes mellitus with diabetic amyotrophy
E10.49 Type 1 diabetes w oth diabetic neurological complication
E10.51 Type 1 diabetes w diabetic peripheral angiopath w/o gangrene
E10.52 Type 1 diabetes w diabetic peripheral angiopathy w gangrene
E10.59 Type 1 diabetes mellitus with oth circulatory complications
E10.610 Type 1 diabetes mellitus w diabetic neuropathic arthropathy
E10.618 Type 1 diabetes mellitus with other diabetic arthropathy
E10.620 Type 1 diabetes mellitus with diabetic dermatitis
E10.621 Type 1 diabetes mellitus with foot ulcer
E10.622 Type 1 diabetes mellitus with other skin ulcer
E10.628 Type 1 diabetes mellitus with other skin complications
E10.630 Type 1 diabetes mellitus with periodontal disease
E10.638 Type 1 diabetes mellitus with other oral complications
E10.641 Type 1 diabetes mellitus with hypoglycemia with coma
E10.649 Type 1 diabetes mellitus with hypoglycemia without coma
E10.65 Type 1 diabetes mellitus with hyperglycemia
E10.69 Type 1 diabetes mellitus with other specified complication
E10.8 Type 1 diabetes mellitus with unspecified complications
E10.9 Type 1 diabetes mellitus without complications
E11.00 Type 2 diab w hyprosm w/o nonket hyprgly-hypros coma (NKHHC)
E11.01 Type 2 diabetes mellitus with hyperosmolarity with coma
E11.10 Type 2 diabetes mellitus with ketoacidosis without coma
E11.11 Type 2 diabetes mellitus with ketoacidosis with coma
E11.21 Type 2 diabetes mellitus with diabetic nephropathy
E11.22 Type 2 diabetes mellitus w diabetic chronic kidney disease
E11.29 Type 2 diabetes mellitus w oth diabetic kidney complication
E11.311 Type 2 diabetes w unsp diabetic retinopathy w macular edema
E11.319 Type 2 diabetes w unsp diabetic rtnop w/o macular edema
E11.3211 Type 2 diab with mild nonp rtnop with macular edema, r eye
E11.3212 Type 2 diab with mild nonp rtnop with macular edema, l eye
E11.3213 Type 2 diabetes with mild nonp rtnop with macular edema, bi
E11.3291 Type 2 diab with mild nonp rtnop without mclr edema, r eye
E11.3292 Type 2 diab with mild nonp rtnop without mclr edema, l eye
E11.3293 Type 2 diab with mild nonp rtnop without macular edema, bi
E11.3311 Type 2 diab with mod nonp rtnop with macular edema, r eye
E11.3312 Type 2 diab with mod nonp rtnop with macular edema, l eye
E11.3313 Type 2 diab with moderate nonp rtnop with macular edema, bi
E11.3391 Type 2 diab with mod nonp rtnop without macular edema, r eye
E11.3392 Type 2 diab with mod nonp rtnop without macular edema, l eye
E11.3393 Type 2 diab with mod nonp rtnop without macular edema, bi
E11.3411 Type 2 diab with severe nonp rtnop with macular edema, r eye
E11.3412 Type 2 diab with severe nonp rtnop with macular edema, l eye
E11.3413 Type 2 diab with severe nonp rtnop with macular edema, bi
E11.3491 Type 2 diab with severe nonp rtnop without mclr edema, r eye
E11.3492 Type 2 diab with severe nonp rtnop without mclr edema, l eye
E11.3493 Type 2 diab with severe nonp rtnop without macular edema, bi
E11.3511 Type 2 diab with prolif diab rtnop with macular edema, r eye
E11.3512 Type 2 diab with prolif diab rtnop with macular edema, l eye
E11.3513 Type 2 diab with prolif diab rtnop with macular edema, bi
E11.3521 Type 2 diab w prolif diab rtnop w trctn dtch macula, r eye
E11.3522 Type 2 diab w prolif diab rtnop w trctn dtch macula, l eye
E11.3523 Type 2 diab w prolif diab rtnop with trctn dtch macula, bi
E11.3531 Type 2 diab w prolif diab rtnop w trctn dtch n-mcla, r eye
E11.3532 Type 2 diab w prolif diab rtnop w trctn dtch n-mcla, l eye
E11.3533 Type 2 diab w prolif diab rtnop with trctn dtch n-mcla, bi
E11.3541 Type 2 diab with prolif diab rtnop with comb detach, r eye
E11.3542 Type 2 diab with prolif diab rtnop with comb detach, l eye
E11.3543 Type 2 diab with prolif diabetic rtnop with comb detach, bi
E11.3551 Type 2 diabetes with stable prolif diabetic rtnop, right eye
E11.3552 Type 2 diabetes with stable prolif diabetic rtnop, left eye
E11.3553 Type 2 diabetes with stable prolif diabetic rtnop, bilateral
E11.3591 Type 2 diab with prolif diab rtnop without mclr edema, r eye
E11.3592 Type 2 diab with prolif diab rtnop without mclr edema, l eye
E11.3593 Type 2 diab with prolif diab rtnop without macular edema, bi
E11.36 Type 2 diabetes mellitus with diabetic cataract
E11.37X1 Type 2 diab with diab mclr edema, resolved fol trtmt, r eye
E11.37X2 Type 2 diab with diab mclr edema, resolved fol trtmt, l eye
E11.37X3 Type 2 diab with diab macular edema, resolved fol trtmt, bi
E11.39 Type 2 diabetes w oth diabetic ophthalmic complication
E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unsp
E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy
E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy
E11.43 Type 2 diabetes w diabetic autonomic (poly)neuropathy
E11.44 Type 2 diabetes mellitus with diabetic amyotrophy
E11.49 Type 2 diabetes w oth diabetic neurological complication
E11.51 Type 2 diabetes w diabetic peripheral angiopath w/o gangrene
E11.52 Type 2 diabetes w diabetic peripheral angiopathy w gangrene
E11.59 Type 2 diabetes mellitus with oth circulatory complications
E11.610 Type 2 diabetes mellitus w diabetic neuropathic arthropathy
E11.618 Type 2 diabetes mellitus with other diabetic arthropathy
E11.620 Type 2 diabetes mellitus with diabetic dermatitis
E11.621 Type 2 diabetes mellitus with foot ulcer
E11.622 Type 2 diabetes mellitus with other skin ulcer
E11.628 Type 2 diabetes mellitus with other skin complications
E11.630 Type 2 diabetes mellitus with periodontal disease
E11.638 Type 2 diabetes mellitus with other oral complications
E11.641 Type 2 diabetes mellitus with hypoglycemia with coma
E11.649 Type 2 diabetes mellitus with hypoglycemia without coma
E11.65 Type 2 diabetes mellitus with hyperglycemia
E11.69 Type 2 diabetes mellitus with other specified complication
E11.8 Type 2 diabetes mellitus with unspecified complications
E11.9 Type 2 diabetes mellitus without complications
E13.00 Oth diab w hyprosm w/o nonket hyprgly-hypros coma (NKHHC)
E13.01 Oth diabetes mellitus with hyperosmolarity with coma
E13.10 Oth diabetes mellitus with ketoacidosis without coma
E13.11 Oth diabetes mellitus with ketoacidosis with coma
E13.21 Other specified diabetes mellitus with diabetic nephropathy
E13.22 Oth diabetes mellitus with diabetic chronic kidney disease
E13.29 Oth diabetes mellitus with oth diabetic kidney complication
E13.311 Oth diabetes w unsp diabetic retinopathy w macular edema
E13.319 Oth diabetes w unsp diabetic retinopathy w/o macular edema
E13.3211 Oth diabetes with mild nonp rtnop with macular edema, r eye
E13.3212 Oth diab with mild nonp rtnop with macular edema, left eye
E13.3213 Oth diabetes with mild nonp rtnop with macular edema, bi
E13.3291 Oth diab with mild nonp rtnop without macular edema, r eye
E13.3292 Oth diab with mild nonp rtnop without macular edema, l eye
E13.3293 Oth diabetes with mild nonp rtnop without macular edema, bi
E13.3311 Oth diab with moderate nonp rtnop with macular edema, r eye
E13.3312 Oth diab with moderate nonp rtnop with macular edema, l eye
E13.3313 Oth diabetes with moderate nonp rtnop with macular edema, bi
E13.3391 Oth diab with mod nonp rtnop without macular edema, r eye
E13.3392 Oth diab with mod nonp rtnop without macular edema, l eye
E13.3393 Oth diab with moderate nonp rtnop without macular edema, bi
E13.3411 Oth diab with severe nonp rtnop with macular edema, r eye
E13.3412 Oth diab with severe nonp rtnop with macular edema, left eye
E13.3413 Oth diabetes with severe nonp rtnop with macular edema, bi
E13.3491 Oth diab with severe nonp rtnop without macular edema, r eye
E13.3492 Oth diab with severe nonp rtnop without macular edema, l eye
E13.3493 Oth diab with severe nonp rtnop without macular edema, bi
E13.3511 Oth diab with prolif diab rtnop with macular edema, r eye
E13.3512 Oth diab with prolif diab rtnop with macular edema, left eye
E13.3513 Oth diab with prolif diabetic rtnop with macular edema, bi
E13.3521 Oth diab w prolif diab rtnop with trctn dtch macula, r eye
E13.3522 Oth diab w prolif diab rtnop with trctn dtch macula, l eye
E13.3523 Oth diab with prolif diab rtnop with trctn dtch macula, bi
E13.3531 Oth diab w prolif diab rtnop with trctn dtch n-mcla, r eye
E13.3532 Oth diab w prolif diab rtnop with trctn dtch n-mcla, l eye
E13.3533 Oth diab with prolif diab rtnop with trctn dtch n-mcla, bi
E13.3541 Oth diab with prolif diabetic rtnop with comb detach, r eye
E13.3542 Oth diab with prolif diab rtnop with comb detach, left eye
E13.3543 Oth diabetes with prolif diabetic rtnop with comb detach, bi
E13.3551 Oth diabetes with stable prolif diabetic rtnop, right eye
E13.3552 Oth diabetes with stable prolif diabetic rtnop, left eye
E13.3553 Oth diabetes with stable prolif diabetic rtnop, bilateral
E13.3591 Oth diab with prolif diab rtnop without macular edema, r eye
E13.3592 Oth diab with prolif diab rtnop without macular edema, l eye
E13.3593 Oth diab with prolif diab rtnop without macular edema, bi
E13.36 Other specified diabetes mellitus with diabetic cataract
E13.37X1 Oth diab with diab macular edema, resolved fol trtmt, r eye
E13.37X2 Oth diab with diab macular edema, resolved fol trtmt, l eye
E13.37X3 Oth diab with diabetic macular edema, resolved fol trtmt, bi
E13.39 Oth diabetes mellitus w oth diabetic ophthalmic complication
E13.40 Oth diabetes mellitus with diabetic neuropathy, unspecified
E13.41 Oth diabetes mellitus with diabetic mononeuropathy
E13.42 Oth diabetes mellitus with diabetic polyneuropathy
E13.43 Oth diabetes mellitus w diabetic autonomic (poly)neuropathy
E13.44 Other specified diabetes mellitus with diabetic amyotrophy
E13.49 Oth diabetes w oth diabetic neurological complication
E13.51 Oth diabetes w diabetic peripheral angiopathy w/o gangrene
E13.52 Oth diabetes w diabetic peripheral angiopathy w gangrene
E13.59 Oth diabetes mellitus with other circulatory complications
E13.610 Oth diabetes mellitus with diabetic neuropathic arthropathy
E13.618 Oth diabetes mellitus with other diabetic arthropathy
E13.620 Other specified diabetes mellitus with diabetic dermatitis
E13.621 Other specified diabetes mellitus with foot ulcer
E13.622 Other specified diabetes mellitus with other skin ulcer
E13.628 Oth diabetes mellitus with other skin complications
E13.630 Other specified diabetes mellitus with periodontal disease
E13.638 Oth diabetes mellitus with other oral complications
E13.641 Oth diabetes mellitus with hypoglycemia with coma
E13.649 Oth diabetes mellitus with hypoglycemia without coma
E13.65 Other specified diabetes mellitus with hyperglycemia
E13.69 Oth diabetes mellitus with other specified complication
E13.8 Oth diabetes mellitus with unspecified complications
E13.9 Other specified diabetes mellitus without complications
E15 Nondiabetic hypoglycemic coma
E16.0 Drug-induced hypoglycemia without coma
E16.1 Other hypoglycemia
E16.2 Hypoglycemia, unspecified
E16.3 Increased secretion of glucagon
E16.8 Other specified disorders of pancreatic internal secretion
E16.9 Disorder of pancreatic internal secretion, unspecified
E31.0 Autoimmune polyglandular failure
E31.1 Polyglandular hyperfunction
E31.20 Multiple endocrine neoplasia [MEN] syndrome, unspecified
E31.21 Multiple endocrine neoplasia [MEN] type I
E31.22 Multiple endocrine neoplasia [MEN] type IIA
E31.23 Multiple endocrine neoplasia [MEN] type IIB
E31.8 Other polyglandular dysfunction
E31.9 Polyglandular dysfunction, unspecified
E74.8 Other specified disorders of carbohydrate metabolism
E79.0 Hyperuricemia w/o signs of inflam arthrit and tophaceous dis
E83.10 Disorder of iron metabolism, unspecified
E83.110 Hereditary hemochromatosis
E83.111 Hemochromatosis due to repeated red blood cell transfusions
E83.118 Other hemochromatosis
E83.119 Hemochromatosis, unspecified
E83.19 Other disorders of iron metabolism
E89.1 Postprocedural hypoinsulinemia
H44.2E1 Degenerative myopia with other maculopathy, right eye
H44.2E2 Degenerative myopia with other maculopathy, left eye
H44.2E3 Degenerative myopia with other maculopathy, bilateral eye
I21.9 Acute myocardial infarction, unspecified
I21.A1 Myocardial infarction type 2
I21.A9 Other myocardial infarction type
K86.0 Alcohol-induced chronic pancreatitis
K86.1 Other chronic pancreatitis
K91.2 Postsurgical malabsorption, not elsewhere classified
L97.115 Non-prs chr ulcer of r thigh with msl invl w/o evd of necr
L97.116 Non-prs chr ulcer of r thigh with bone invl w/o evd of necr
L97.118 Non-pressure chronic ulcer of right thigh with oth severity
L97.125 Non-prs chr ulc of left thigh with msl invl w/o evd of necr
L97.126 Non-prs chr ulc of left thigh with bone invl w/o evd of necr
L97.128 Non-pressure chronic ulcer of left thigh with oth severity
L97.215 Non-prs chr ulcer of r calf with msl invl w/o evd of necr
L97.216 Non-prs chr ulcer of r calf with bone invl w/o evd of necr
L97.218 Non-pressure chronic ulcer of right calf with oth severity
L97.225 Non-prs chr ulcer of left calf with msl invl w/o evd of necr
L97.226 Non-prs chr ulc of left calf with bone invl w/o evd of necr
L97.228 Non-pressure chronic ulcer of left calf with oth severity
L97.315 Non-prs chr ulcer of r ankle with msl invl w/o evd of necr
L97.316 Non-prs chr ulcer of r ankle with bone invl w/o evd of necr
L97.318 Non-pressure chronic ulcer of right ankle with oth severity
L97.325 Non-prs chr ulcer of l ankle with msl invl w/o evd of necr
L97.326 Non-prs chr ulcer of l ankle with bone invl w/o evd of necr
L97.328 Non-pressure chronic ulcer of left ankle with oth severity
L97.415 Non-prs chr ulc of r heel/midft w msl invl w/o evd of necr
L97.416 Non-prs chr ulc of r heel/midft w bne invl w/o evd of necr
L97.418 Non-prs chronic ulcer of right heel/midft with oth severity
L97.425 Non-prs chr ulc of l heel/midft w msl invl w/o evd of necr
L97.426 Non-prs chr ulc of l heel/midft w bne invl w/o evd of necr
L97.428 Non-prs chronic ulcer of left heel/midft with oth severity
L97.515 Non-prs chr ulc oth prt r foot with msl invl w/o evd of necr
L97.516 Non-prs chr ulc oth prt r foot with bne invl w/o evd of necr
L97.518 Non-prs chronic ulcer oth prt right foot with oth severity
L97.525 Non-prs chr ulc oth prt l foot with msl invl w/o evd of necr
L97.526 Non-prs chr ulc oth prt l foot with bne invl w/o evd of necr
L97.528 Non-prs chronic ulcer oth prt left foot with oth severity
L97.815 Non-prs chr ulc oth prt r low leg w msl invl w/o evd of necr
L97.816 Non-prs chr ulc oth prt r low leg w bne invl w/o evd of necr
L97.818 Non-prs chronic ulcer oth prt r low leg with oth severity
L97.825 Non-prs chr ulc oth prt l low leg w msl invl w/o evd of necr
L97.826 Non-prs chr ulc oth prt l low leg w bne invl w/o evd of necr
L97.828 Non-prs chronic ulcer oth prt l low leg with oth severity
L97.915 Non-prs chr ulc unsp prt r lw leg w msl invl w/o evd of necr
L97.916 Non-prs chr ulc unsp prt r lw leg w bne invl w/o evd of necr
L97.918 Non-prs chronic ulc unsp prt of r low leg with oth severity
L97.925 Non-prs chr ulc unsp prt l lw leg w msl invl w/o evd of necr
L97.926 Non-prs chr ulc unsp prt l lw leg w bne invl w/o evd of necr
L97.928 Non-prs chronic ulc unsp prt of l low leg with oth severity
L98.415 Non-prs chr ulcer of buttock with msl invl w/o evd of necr
L98.416 Non-prs chr ulcer of buttock with bone invl w/o evd of necr
L98.418 Non-pressure chronic ulcer of buttock with oth severity
L98.425 Non-prs chr ulcer of back with muscle invl w/o evd of necr
L98.426 Non-prs chr ulcer of back with bone invl without evd of necr
L98.428 Non-pressure chronic ulcer of back with oth severity
L98.495 Non-prs chr ulc skin/ oth site with msl invl w/o evd of necr
L98.496 Non-prs chr ulc skin/ oth site with bne invl w/o evd of necr
O24.011 Pre-existing type 1 diabetes, in pregnancy, first trimester
O24.012 Pre-existing type 1 diabetes, in pregnancy, second trimester
O24.013 Pre-existing type 1 diabetes, in pregnancy, third trimester
O24.019 Pre-exist type 1 diabetes, in pregnancy, unsp trimester
O24.03 Pre-existing type 1 diabetes mellitus, in the puerperium
O24.111 Pre-existing type 2 diabetes, in pregnancy, first trimester
O24.112 Pre-existing type 2 diabetes, in pregnancy, second trimester
O24.113 Pre-existing type 2 diabetes, in pregnancy, third trimester
O24.119 Pre-exist type 2 diabetes, in pregnancy, unsp trimester
O24.13 Pre-existing type 2 diabetes mellitus, in the puerperium
O24.311 Unsp pre-existing diabetes in pregnancy, first trimester
O24.312 Unsp pre-existing diabetes in pregnancy, second trimester
O24.313 Unsp pre-existing diabetes in pregnancy, third trimester
O24.319 Unsp pre-existing diabetes in pregnancy, unsp trimester
O24.33 Unspecified pre-existing diabetes mellitus in the puerperium
O24.410 Gestational diabetes mellitus in pregnancy, diet controlled
O24.414 Gestational diabetes in pregnancy, insulin controlled
O24.419 Gestational diabetes mellitus in pregnancy, unsp control
O24.430 Gestational diabetes in the puerperium, diet controlled
O24.434 Gestational diabetes in the puerperium, insulin controlled
O24.439 Gestational diabetes in the puerperium, unsp control
O24.811 Oth pre-existing diabetes in pregnancy, first trimester
O24.812 Oth pre-existing diabetes in pregnancy, second trimester
O24.813 Oth pre-existing diabetes in pregnancy, third trimester
O24.819 Oth pre-existing diabetes in pregnancy, unsp trimester
O24.83 Other pre-existing diabetes mellitus in the puerperium
O24.911 Unspecified diabetes mellitus in pregnancy, first trimester
O24.912 Unspecified diabetes mellitus in pregnancy, second trimester
O24.913 Unspecified diabetes mellitus in pregnancy, third trimester
O24.919 Unsp diabetes mellitus in pregnancy, unspecified trimester
O24.93 Unspecified diabetes mellitus in the puerperium
O99.810 Abnormal glucose complicating pregnancy
O99.815 Abnormal glucose complicating the puerperium
R73.01 Impaired fasting glucose
R73.02 Impaired glucose tolerance (oral)
R73.03 Prediabetes
R73.09 Other abnormal glucose
R73.9 Hyperglycemia, unspecified
R78.71 Abnormal lead level in blood
R78.79 Finding of abnormal level of heavy metals in blood
R78.89 Finding of oth substances, not normally found in blood
R79.0 Abnormal level of blood mineral
R79.89 Other specified abnormal findings of blood chemistry
R79.9 Abnormal finding of blood chemistry, unspecified
T38.3X1A Poisoning by insulin and oral hypoglycemic drugs, acc, init
T38.3X2A Poisn by insulin and oral hypoglycemic drugs, slf-hrm, init
T38.3X3A Poisn by insulin and oral hypoglycemic drugs, assault, init
T38.3X4A Poisn by insulin and oral hypoglycemic drugs, undet, init
Z79.3 Long term (current) use of hormonal contraceptives
Z79.4 Long term (current) use of insulin
Z79.84 Long term (current) use of oral hypoglycemic drugs
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
Z86.2 Prsnl history of dis of the bld/bld-form org/immun mechnsm
Z86.31 Personal history of diabetic foot ulcer
Z86.32 Personal history of gestational diabetes
Z86.39 Personal history of endo, nutritional and metabolic disease

The content and format of the following files and/or webpages are copywritten and the property of Wheaton Partners, LLC - dba CodeMap®. All recipients of these files agree not to distribute, reproduce and/or use the information contained within, in any manner not expressly agreed upon by the user and Wheaton Partners, LLC - dba CodeMap®.

All code-pairs and Medicare coverage information are compiled directly from Center for Medicare and Medicaid Services (CMS) and Medicare Contractor coverage policies. CodeMap® has made every reasonable effort to ensure the accuracy of the information contained. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. Both CMS and Medicare contractor coverage policy information may change at any time. CodeMap® makes no representation, warranty, or guarantee that this compilation of coverage policy information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.


CodeMap® is a Registered Trademark of Wheaton Partners, LLC.