ICD↔CPT crosswalk
CPT 86790: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 86790 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 86790 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 |
|---|---|
| A92.5 | Zika virus disease |
| B30.9 | Viral conjunctivitis, unspecified |
| M25.50 | Pain in unspecified joint |
| M25.511 | Pain in right shoulder |
| M25.512 | Pain in left shoulder |
| M25.519 | Pain in unspecified shoulder |
| M25.521 | Pain in right elbow |
| M25.522 | Pain in left elbow |
| M25.529 | Pain in unspecified elbow |
| M25.531 | Pain in right wrist |
| M25.532 | Pain in left wrist |
| M25.539 | Pain in unspecified wrist |
| M25.551 | Pain in right hip |
| M25.552 | Pain in left hip |
| M25.559 | Pain in unspecified hip |
| M25.561 | Pain in right knee |
| M25.562 | Pain in left knee |
| M25.569 | Pain in unspecified knee |
| M25.571 | Pain in right ankle and joints of right foot |
| M25.572 | Pain in left ankle and joints of left foot |
| M25.579 | Pain in unspecified ankle and joints of unspecified foot |
| O09.00 | Supervision of pregnancy with history of infertility, unspecified trimester |
| O09.01 | Supervision of pregnancy with history of infertility, first trimester |
| O09.02 | Supervision of pregnancy with history of infertility, second trimester |
| O09.03 | Supervision of pregnancy with history of infertility, third trimester |
| O09.10 | Supervision of pregnancy with history of ectopic pregnancy, unspecified trimester |
| O09.11 | Supervision of pregnancy with history of ectopic pregnancy, first trimester |
| O09.12 | Supervision of pregnancy with history of ectopic pregnancy, second trimester |
| O09.13 | Supervision of pregnancy with history of ectopic pregnancy, third trimester |
| O09.211 | Supervision of pregnancy with history of pre-term labor, first trimester |
| O09.212 | Supervision of pregnancy with history of pre-term labor, second trimester |
| O09.213 | Supervision of pregnancy with history of pre-term labor, third trimester |
| O09.219 | Supervision of pregnancy with history of pre-term labor, unspecified trimester |
| O09.291 | Supervision of pregnancy with other poor reproductive or obstetric history, first trimester |
| O09.292 | Supervision of pregnancy with other poor reproductive or obstetric history, second trimester |
| O09.293 | Supervision of pregnancy with other poor reproductive or obstetric history, third trimester |
| O09.299 | Supervision of pregnancy with other poor reproductive or obstetric history, unspecified trimester |
| O09.30 | Supervision of pregnancy with insufficient antenatal care, unspecified trimester |
| O09.31 | Supervision of pregnancy with insufficient antenatal care, first trimester |
| O09.32 | Supervision of pregnancy with insufficient antenatal care, second trimester |
| O09.33 | Supervision of pregnancy with insufficient antenatal care, third trimester |
| O09.40 | Supervision of pregnancy with grand multiparity, unspecified trimester |
| O09.41 | Supervision of pregnancy with grand multiparity, first trimester |
| O09.42 | Supervision of pregnancy with grand multiparity, second trimester |
| O09.43 | Supervision of pregnancy with grand multiparity, third trimester |
| O09.511 | Supervision of elderly primigravida, first trimester |
| O09.512 | Supervision of elderly primigravida, second trimester |
| O09.513 | Supervision of elderly primigravida, third trimester |
| O09.519 | Supervision of elderly primigravida, unspecified trimester |
| O09.521 | Supervision of elderly multigravida, first trimester |
| O09.522 | Supervision of elderly multigravida, second trimester |
| O09.523 | Supervision of elderly multigravida, third trimester |
| O09.529 | Supervision of elderly multigravida, unspecified trimester |
| O09.611 | Supervision of young primigravida, first trimester |
| O09.612 | Supervision of young primigravida, second trimester |
| O09.613 | Supervision of young primigravida, third trimester |
| O09.619 | Supervision of young primigravida, unspecified trimester |
| O09.621 | Supervision of young multigravida, first trimester |
| O09.622 | Supervision of young multigravida, second trimester |
| O09.623 | Supervision of young multigravida, third trimester |
| O09.629 | Supervision of young multigravida, unspecified trimester |
| O09.70 | Supervision of high risk pregnancy due to social problems, unspecified trimester |
| O09.71 | Supervision of high risk pregnancy due to social problems, first trimester |
| O09.72 | Supervision of high risk pregnancy due to social problems, second trimester |
| O09.73 | Supervision of high risk pregnancy due to social problems, third trimester |
| O09.811 | Supervision of pregnancy resulting from assisted reproductive technology, first trimester |
| O09.812 | Supervision of pregnancy resulting from assisted reproductive technology, second trimester |
| O09.813 | Supervision of pregnancy resulting from assisted reproductive technology, third trimester |
| O09.819 | Supervision of pregnancy resulting from assisted reproductive technology, unspecified trimester |
| O09.821 | Supervision of pregnancy with history of in utero procedure during previous pregnancy, first trimester |
| O09.822 | Supervision of pregnancy with history of in utero procedure during previous pregnancy, second trimester |
| O09.823 | Supervision of pregnancy with history of in utero procedure during previous pregnancy, third trimester |
| O09.829 | Supervision of pregnancy with history of in utero procedure during previous pregnancy, unspecified trimester |
| O09.891 | Supervision of other high risk pregnancies, first trimester |
| O09.892 | Supervision of other high risk pregnancies, second trimester |
| O09.893 | Supervision of other high risk pregnancies, third trimester |
| O09.899 | Supervision of other high risk pregnancies, unspecified trimester |
| O09.90 | Supervision of high risk pregnancy, unspecified, unspecified trimester |
| O09.91 | Supervision of high risk pregnancy, unspecified, first trimester |
| O09.92 | Supervision of high risk pregnancy, unspecified, second trimester |
| O09.93 | Supervision of high risk pregnancy, unspecified, third trimester |
| O28.3 | Abnormal ultrasonic finding on antenatal screening of mother |
| O28.4 | Abnormal radiological finding on antenatal screening of mother |
| O35.00X1 | Maternal care for (suspected) central nervous system malformation or damage in fetus, unspecified, fetus 1 |
| O35.00X2 | Maternal care for (suspected) central nervous system malformation or damage in fetus, unspecified, fetus 2 |
| O35.00X3 | Maternal care for (suspected) central nervous system malformation or damage in fetus, unspecified, fetus 3 |
| O35.00X4 | Maternal care for (suspected) central nervous system malformation or damage in fetus, unspecified, fetus 4 |
| O35.00X5 | Maternal care for (suspected) central nervous system malformation or damage in fetus, unspecified, fetus 5 |
| O35.00X9 | Maternal care for (suspected) central nervous system malformation or damage in fetus, unspecified, other fetus |
| O35.07X1 | Maternal care for (suspected) central nervous system malformation or damage in fetus, microcephaly, fetus 1 |
| O35.07X2 | Maternal care for (suspected) central nervous system malformation or damage in fetus, microcephaly, fetus 2 |
| O35.07X3 | Maternal care for (suspected) central nervous system malformation or damage in fetus, microcephaly, fetus 3 |
| O35.07X4 | Maternal care for (suspected) central nervous system malformation or damage in fetus, microcephaly, fetus 4 |
| O35.07X5 | Maternal care for (suspected) central nervous system malformation or damage in fetus, microcephaly, fetus 5 |
| O35.07X9 | Maternal care for (suspected) central nervous system malformation or damage in fetus, microcephaly, other fetus |
| O35.09X1 | Maternal care for (suspected) other central nervous system malformation or damage in fetus, fetus 1 |
| O35.09X2 | Maternal care for (suspected) other central nervous system malformation or damage in fetus, fetus 2 |
| O35.09X3 | Maternal care for (suspected) other central nervous system malformation or damage in fetus, fetus 3 |
| O35.09X4 | Maternal care for (suspected) other central nervous system malformation or damage in fetus, fetus 4 |
| O35.09X5 | Maternal care for (suspected) other central nervous system malformation or damage in fetus, fetus 5 |
| O35.09X9 | Maternal care for (suspected) other central nervous system malformation or damage in fetus, other fetus |
| O35.3XX0 | Maternal care for (suspected) damage to fetus from viral disease in mother, not applicable or unspecified |
| O35.3XX1 | Maternal care for (suspected) damage to fetus from viral disease in mother, fetus 1 |
| O35.3XX2 | Maternal care for (suspected) damage to fetus from viral disease in mother, fetus 2 |
| O35.3XX3 | Maternal care for (suspected) damage to fetus from viral disease in mother, fetus 3 |
| O35.3XX4 | Maternal care for (suspected) damage to fetus from viral disease in mother, fetus 4 |
| O35.3XX5 | Maternal care for (suspected) damage to fetus from viral disease in mother, fetus 5 |
| O35.3XX9 | Maternal care for (suspected) damage to fetus from viral disease in mother, other fetus |
| R21 | Rash and other nonspecific skin eruption |
| R50.9 | Fever, unspecified |
| Z03.73 | Encounter for suspected fetal anomaly ruled out |
| Z03.79 | Encounter for other suspected maternal and fetal conditions ruled out |
| Z03.89 | Encounter for observation for other suspected diseases and conditions ruled out |
| Z20.821 | Contact with and (suspected) exposure to Zika virus |
| Z33.1 | Pregnant state, incidental |
| Z34.00 | Encounter for supervision of normal first pregnancy, unspecified trimester |
| Z34.01 | Encounter for supervision of normal first pregnancy, first trimester |
| Z34.02 | Encounter for supervision of normal first pregnancy, second trimester |
| Z34.03 | Encounter for supervision of normal first pregnancy, third trimester |
| Z34.80 | Encounter for supervision of other normal pregnancy, unspecified trimester |
| Z34.81 | Encounter for supervision of other normal pregnancy, first trimester |
| Z34.82 | Encounter for supervision of other normal pregnancy, second trimester |
| Z34.83 | Encounter for supervision of other normal pregnancy, third trimester |
| Z34.90 | Encounter for supervision of normal pregnancy, unspecified, unspecified trimester |
| Z34.91 | Encounter for supervision of normal pregnancy, unspecified, first trimester |
| Z34.92 | Encounter for supervision of normal pregnancy, unspecified, second trimester |
| Z34.93 | Encounter for supervision of normal pregnancy, unspecified, third trimester |
| Z36.89 | Encounter for other specified antenatal screening |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 86790?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 128 ICD-10 diagnosis codes that support medical necessity for CPT 86790. 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 86790 view of that relationship.
Catch medical-necessity denials before you bill. CareNiva scrubs claims against LCD/NCD coverage and flags unsupported diagnoses — in the same platform you run visits and billing.
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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