CPT 0540U: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 0540U under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 0540U 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 |
|---|---|
| T86.10 | Unspecified complication of kidney transplant |
| T86.19 | Other complication of kidney transplant |
| T86.20 | Unspecified complication of heart transplant |
| T86.298 | Other complications of heart transplant |
| T86.30 | Unspecified complication of heart-lung transplant |
| T86.810 | Lung transplant rejection |
| T86.818 | Other complications of lung transplant |
| T86.819 | Unspecified complication of lung transplant |
| XX0.00 | |
| Z48.21 | Encounter for aftercare following heart transplant |
| Z48.22 | Encounter for aftercare following kidney transplant |
| Z48.24 | Encounter for aftercare following lung transplant |
| Z94.0 | Kidney transplant status |
| Z94.1 | Heart transplant status |
| Z94.2 | Lung transplant status |
| Z94.3 | Heart and lungs transplant status |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 0540U?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 16 ICD-10 diagnosis codes that support medical necessity for CPT 0540U. 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 0540U 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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