CPT 86294: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 86294 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 86294 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 |
| C7A.010 | Malignant carcinoid tumor of the duodenum |
| C7A.011 | Malignant carcinoid tumor of the jejunum |
| C7A.012 | Malignant carcinoid tumor of the ileum |
| C7A.020 | Malignant carcinoid tumor of the appendix |
| C7A.021 | Malignant carcinoid tumor of the cecum |
| C7A.022 | Malignant carcinoid tumor of the ascending colon |
| C7A.023 | Malignant carcinoid tumor of the transverse colon |
| C7A.024 | Malignant carcinoid tumor of the descending colon |
| C7A.025 | Malignant carcinoid tumor of the sigmoid colon |
| C7A.026 | Malignant carcinoid tumor of the rectum |
| C7A.090 | Malignant carcinoid tumor of the bronchus and lung |
| C7A.091 | Malignant carcinoid tumor of the thymus |
| C7A.092 | Malignant carcinoid tumor of the stomach |
| C7A.093 | Malignant carcinoid tumor of the kidney |
| C7A.098 | Malignant carcinoid tumors of other sites |
| C7A.8 | Other malignant neuroendocrine tumors |
| C7B.01 | Secondary carcinoid tumors of distant lymph nodes |
| C7B.02 | Secondary carcinoid tumors of liver |
| C7B.03 | Secondary carcinoid tumors of bone |
| C7B.04 | Secondary carcinoid tumors of peritoneum |
| C7B.09 | Secondary carcinoid tumors of other sites |
| C7B.8 | Other secondary neuroendocrine tumors |
| D09.0 | Carcinoma in situ of bladder |
| D41.4 | Neoplasm of uncertain behavior of bladder |
| D49.4 | Neoplasm of unspecified behavior of bladder |
| E34.00 | Carcinoid syndrome, unspecified |
| E34.01 | Carcinoid heart syndrome |
| E34.09 | Other carcinoid syndrome |
| R10.20 | Pelvic and perineal pain unspecified side |
| R10.21 | Pelvic and perineal pain right side |
| R10.22 | Pelvic and perineal pain left side |
| R10.23 | Pelvic and perineal pain bilateral |
| R10.24 | Suprapubic pain |
| R10.85 | Abdominal pain of multiple sites |
| R10.8A1 | Right flank tenderness |
| R10.8A2 | Left flank tenderness |
| R10.8A3 | Suprapubic tenderness |
| R10.8A9 | Flank tenderness, unspecified |
| R10.A0 | Flank pain, unspecified side |
| R10.A1 | Flank pain, right side |
| R10.A2 | Flank pain, left side |
| R10.A3 | Flank pain, bilateral |
| R31.0 | Gross hematuria |
| R31.1 | Benign essential microscopic hematuria |
| R31.21 | Asymptomatic microscopic hematuria |
| R31.29 | Other microscopic hematuria |
| R76.81 | Abnormal rheumatoid factor and anti-citrullinated protein antibody without rheumatoid arthritis |
| R76.89 | Other specified abnormal immunological findings in serum |
| Z78.9 | Other specified health status |
| Z85.51 | Personal history of malignant neoplasm of bladder |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 86294?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 60 ICD-10 diagnosis codes that support medical necessity for CPT 86294. 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 86294 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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