CPT 0420U: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 0420U under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 0420U with a diagnosis that isn't covered typically denies as CARC 50 — not medically necessary.
National approximation. Coverage varies by MAC and state — confirm against the specific LCD/NCD and article that applies to your jurisdiction and date of service.
| ICD-10 | Description |
|---|---|
| C67.0 | Malignant neoplasm of trigone of bladder |
| C67.1 | Malignant neoplasm of dome of bladder |
| C67.2 | Malignant neoplasm of lateral wall of bladder |
| C67.3 | Malignant neoplasm of anterior wall of bladder |
| C67.4 | Malignant neoplasm of posterior wall of bladder |
| C67.5 | Malignant neoplasm of bladder neck |
| C67.6 | Malignant neoplasm of ureteric orifice |
| C67.7 | Malignant neoplasm of urachus |
| C67.8 | Malignant neoplasm of overlapping sites of bladder |
| C67.9 | Malignant neoplasm of bladder, unspecified |
| D09.0 | Carcinoma in situ of bladder |
| D09.10 | Carcinoma in situ of unspecified urinary organ |
| D09.19 | Carcinoma in situ of other urinary organs |
| D49.4 | Neoplasm of unspecified behavior of bladder |
| E85.89 | Other amyloidosis |
| R31.0 | Gross hematuria |
| R31.1 | Benign essential microscopic hematuria |
| R31.21 | Asymptomatic microscopic hematuria |
| R31.29 | Other microscopic hematuria |
| R31.9 | Hematuria, unspecified |
| XX0.00 |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 0420U?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 21 ICD-10 diagnosis codes that support medical necessity for CPT 0420U. The covered codes are listed on this page. Coverage varies by MAC/state — always confirm against the policy that applies to you.
What is a medical-necessity (LCD/NCD) crosswalk?
A claim whose procedure isn't supported by a covered diagnosis denies as "not medically necessary" (CARC 50). CMS coverage policies define which diagnoses justify a procedure; this page is the ICD-10 → CPT 0420U view of that relationship.
More free billing tools: all crosswalks · NCCI edits · Medicare fees · denial codes
Informational only, not coding, billing, or legal advice. Based on CMS Medicare Coverage Database data; verify the current LCD/NCD for your MAC before billing.
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