CPT 68811: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 68811 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 68811 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 |
|---|---|
| H04.201 | Unspecified epiphora, right side |
| H04.202 | Unspecified epiphora, left side |
| H04.203 | Unspecified epiphora, bilateral |
| H04.221 | Epiphora due to insufficient drainage, right side |
| H04.222 | Epiphora due to insufficient drainage, left side |
| H04.223 | Epiphora due to insufficient drainage, bilateral |
| H04.411 | Chronic dacryocystitis of right lacrimal passage |
| H04.412 | Chronic dacryocystitis of left lacrimal passage |
| H04.413 | Chronic dacryocystitis of bilateral lacrimal passages |
| H04.431 | Chronic lacrimal mucocele of right lacrimal passage |
| H04.432 | Chronic lacrimal mucocele of left lacrimal passage |
| H04.433 | Chronic lacrimal mucocele of bilateral lacrimal passages |
| H04.541 | Stenosis of right lacrimal canaliculi |
| H04.542 | Stenosis of left lacrimal canaliculi |
| H04.543 | Stenosis of bilateral lacrimal canaliculi |
| H04.551 | Acquired stenosis of right nasolacrimal duct |
| H04.552 | Acquired stenosis of left nasolacrimal duct |
| H04.553 | Acquired stenosis of bilateral nasolacrimal duct |
| H04.561 | Stenosis of right lacrimal punctum |
| H04.562 | Stenosis of left lacrimal punctum |
| H04.563 | Stenosis of bilateral lacrimal punctum |
| H10.401 | Unspecified chronic conjunctivitis, right eye |
| H10.402 | Unspecified chronic conjunctivitis, left eye |
| H10.403 | Unspecified chronic conjunctivitis, bilateral |
| H10.421 | Simple chronic conjunctivitis, right eye |
| H10.422 | Simple chronic conjunctivitis, left eye |
| H10.423 | Simple chronic conjunctivitis, bilateral |
| H10.431 | Chronic follicular conjunctivitis, right eye |
| H10.432 | Chronic follicular conjunctivitis, left eye |
| H10.433 | Chronic follicular conjunctivitis, bilateral |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 68811?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 30 ICD-10 diagnosis codes that support medical necessity for CPT 68811. 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 68811 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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