ICD↔CPT crosswalk
CPT 87428: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 87428 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 87428 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 |
|---|---|
| B97.29 | Other coronavirus as the cause of diseases classified elsewhere |
| D80.0 | Hereditary hypogammaglobulinemia |
| D80.1 | Nonfamilial hypogammaglobulinemia |
| D80.2 | Selective deficiency of immunoglobulin A [IgA] |
| D80.3 | Selective deficiency of immunoglobulin G [IgG] subclasses |
| D80.4 | Selective deficiency of immunoglobulin M [IgM] |
| D80.5 | Immunodeficiency with increased immunoglobulin M [IgM] |
| D80.6 | Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia |
| D80.8 | Other immunodeficiencies with predominantly antibody defects |
| D81.0 | Severe combined immunodeficiency [SCID] with reticular dysgenesis |
| D81.1 | Severe combined immunodeficiency [SCID] with low T- and B-cell numbers |
| D81.2 | Severe combined immunodeficiency [SCID] with low or normal B-cell numbers |
| D81.31 | Severe combined immunodeficiency due to adenosine deaminase deficiency |
| D81.32 | Adenosine deaminase 2 deficiency |
| D81.39 | Other adenosine deaminase deficiency |
| D81.4 | Nezelof's syndrome |
| D81.5 | Purine nucleoside phosphorylase [PNP] deficiency |
| D81.6 | Major histocompatibility complex class I deficiency |
| D81.7 | Major histocompatibility complex class II deficiency |
| D81.810 | Biotinidase deficiency |
| D81.818 | Other biotin-dependent carboxylase deficiency |
| D81.89 | Other combined immunodeficiencies |
| D82.0 | Wiskott-Aldrich syndrome |
| D82.1 | Di George's syndrome |
| D82.2 | Immunodeficiency with short-limbed stature |
| D82.3 | Immunodeficiency following hereditary defective response to Epstein-Barr virus |
| D82.4 | Hyperimmunoglobulin E [IgE] syndrome |
| D82.8 | Immunodeficiency associated with other specified major defects |
| D83.0 | Common variable immunodeficiency with predominant abnormalities of B-cell numbers and function |
| D83.1 | Common variable immunodeficiency with predominant immunoregulatory T-cell disorders |
| D83.2 | Common variable immunodeficiency with autoantibodies to B- or T-cells |
| D83.8 | Other common variable immunodeficiencies |
| D84.0 | Lymphocyte function antigen-1 [LFA-1] defect |
| D84.1 | Defects in the complement system |
| D89.0 | Polyclonal hypergammaglobulinemia |
| D89.1 | Cryoglobulinemia |
| D89.2 | Hypergammaglobulinemia, unspecified |
| D89.3 | Immune reconstitution syndrome |
| D89.41 | Monoclonal mast cell activation syndrome |
| D89.42 | Idiopathic mast cell activation syndrome |
| D89.43 | Secondary mast cell activation |
| D89.49 | Other mast cell activation disorder |
| D89.810 | Acute graft-versus-host disease |
| D89.811 | Chronic graft-versus-host disease |
| D89.812 | Acute on chronic graft-versus-host disease |
| D89.82 | Autoimmune lymphoproliferative syndrome [ALPS] |
| D89.89 | Other specified disorders involving the immune mechanism, not elsewhere classified |
| E84.0 | Cystic fibrosis with pulmonary manifestations |
| E84.19 | Cystic fibrosis with other intestinal manifestations |
| E84.8 | Cystic fibrosis with other manifestations |
| I27.0 | Primary pulmonary hypertension |
| I27.21 | Secondary pulmonary arterial hypertension |
| I27.22 | Pulmonary hypertension due to left heart disease |
| I27.23 | Pulmonary hypertension due to lung diseases and hypoxia |
| I27.24 | Chronic thromboembolic pulmonary hypertension |
| I27.29 | Other secondary pulmonary hypertension |
| I27.81 | Cor pulmonale (chronic) |
| I27.82 | Chronic pulmonary embolism |
| I27.83 | Eisenmenger's syndrome |
| I27.89 | Other specified pulmonary heart diseases |
| I50.21 | Acute systolic (congestive) heart failure |
| I50.22 | Chronic systolic (congestive) heart failure |
| I50.23 | Acute on chronic systolic (congestive) heart failure |
| I50.31 | Acute diastolic (congestive) heart failure |
| I50.32 | Chronic diastolic (congestive) heart failure |
| I50.33 | Acute on chronic diastolic (congestive) heart failure |
| I50.41 | Acute combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.42 | Chronic combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.43 | Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.811 | Acute right heart failure |
| I50.812 | Chronic right heart failure |
| I50.813 | Acute on chronic right heart failure |
| I50.814 | Right heart failure due to left heart failure |
| I50.82 | Biventricular heart failure |
| I50.83 | High output heart failure |
| I50.84 | End stage heart failure |
| I50.89 | Other heart failure |
| J00 | Acute nasopharyngitis [common cold] |
| J02.9 | Acute pharyngitis, unspecified |
| J04.0 | Acute laryngitis |
| J04.10 | Acute tracheitis without obstruction |
| J04.11 | Acute tracheitis with obstruction |
| J04.2 | Acute laryngotracheitis |
| J04.30 | Supraglottitis, unspecified, without obstruction |
| J04.31 | Supraglottitis, unspecified, with obstruction |
| J05.0 | Acute obstructive laryngitis [croup] |
| J05.10 | Acute epiglottitis without obstruction |
| J05.11 | Acute epiglottitis with obstruction |
| J06.0 | Acute laryngopharyngitis |
| J06.9 | Acute upper respiratory infection, unspecified |
| J09.X1 | Influenza due to identified novel influenza A virus with pneumonia |
| J09.X2 | Influenza due to identified novel influenza A virus with other respiratory manifestations |
| J09.X3 | Influenza due to identified novel influenza A virus with gastrointestinal manifestations |
| J09.X9 | Influenza due to identified novel influenza A virus with other manifestations |
| J10.1 | Influenza due to other identified influenza virus with other respiratory manifestations |
| J12.0 | Adenoviral pneumonia |
| J12.3 | Human metapneumovirus pneumonia |
| J12.81 | Pneumonia due to SARS-associated coronavirus |
| J12.82 | Pneumonia due to coronavirus disease 2019 |
| J12.89 | Other viral pneumonia |
| J12.9 | Viral pneumonia, unspecified |
| J15.8 | Pneumonia due to other specified bacteria |
| J16.8 | Pneumonia due to other specified infectious organisms |
| J18.0 | Bronchopneumonia, unspecified organism |
| J18.1 | Lobar pneumonia, unspecified organism |
| J18.2 | Hypostatic pneumonia, unspecified organism |
| J18.8 | Other pneumonia, unspecified organism |
| J18.9 | Pneumonia, unspecified organism |
| J20.8 | Acute bronchitis due to other specified organisms |
| J22 | Unspecified acute lower respiratory infection |
| J41.0 | Simple chronic bronchitis |
| J41.1 | Mucopurulent chronic bronchitis |
| J41.8 | Mixed simple and mucopurulent chronic bronchitis |
| J43.0 | Unilateral pulmonary emphysema [MacLeod's syndrome] |
| J43.1 | Panlobular emphysema |
| J43.2 | Centrilobular emphysema |
| J43.8 | Other emphysema |
| J44.0 | Chronic obstructive pulmonary disease with (acute) lower respiratory infection |
| J44.1 | Chronic obstructive pulmonary disease with (acute) exacerbation |
| J45.21 | Mild intermittent asthma with (acute) exacerbation |
| J45.22 | Mild intermittent asthma with status asthmaticus |
| J45.30 | Mild persistent asthma, uncomplicated |
| J45.31 | Mild persistent asthma with (acute) exacerbation |
| J45.32 | Mild persistent asthma with status asthmaticus |
| J45.40 | Moderate persistent asthma, uncomplicated |
| J45.41 | Moderate persistent asthma with (acute) exacerbation |
| J45.42 | Moderate persistent asthma with status asthmaticus |
| J45.50 | Severe persistent asthma, uncomplicated |
| J45.51 | Severe persistent asthma with (acute) exacerbation |
| J45.52 | Severe persistent asthma with status asthmaticus |
| J45.991 | Cough variant asthma |
| J45.998 | Other asthma |
| J47.0 | Bronchiectasis with acute lower respiratory infection |
| J47.1 | Bronchiectasis with (acute) exacerbation |
| J47.9 | Bronchiectasis, uncomplicated |
| J60 | Coalworker's pneumoconiosis |
| J61 | Pneumoconiosis due to asbestos and other mineral fibers |
| J62.0 | Pneumoconiosis due to talc dust |
| J62.8 | Pneumoconiosis due to other dust containing silica |
| J63.0 | Aluminosis (of lung) |
| J63.1 | Bauxite fibrosis (of lung) |
| J63.2 | Berylliosis |
| J63.3 | Graphite fibrosis (of lung) |
| J63.4 | Siderosis |
| J63.5 | Stannosis |
| J63.6 | Pneumoconiosis due to other specified inorganic dusts |
| J65 | Pneumoconiosis associated with tuberculosis |
| J66.0 | Byssinosis |
| J66.1 | Flax-dressers' disease |
| J66.2 | Cannabinosis |
| J66.8 | Airway disease due to other specific organic dusts |
| J70.1 | Chronic and other pulmonary manifestations due to radiation |
| J70.3 | Chronic drug-induced interstitial lung disorders |
| J81.1 | Chronic pulmonary edema |
| J84.10 | Pulmonary fibrosis, unspecified |
| J84.111 | Idiopathic interstitial pneumonia, not otherwise specified |
| J84.112 | Idiopathic pulmonary fibrosis |
| J84.113 | Idiopathic non-specific interstitial pneumonitis |
| J84.114 | Acute interstitial pneumonitis |
| J84.115 | Respiratory bronchiolitis interstitial lung disease |
| J84.116 | Cryptogenic organizing pneumonia |
| J84.117 | Desquamative interstitial pneumonia |
| J84.170 | Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere |
| J84.178 | Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere |
| J84.2 | Lymphoid interstitial pneumonia |
| J84.81 | Lymphangioleiomyomatosis |
| J84.82 | Adult pulmonary Langerhans cell histiocytosis |
| J84.89 | Other specified interstitial pulmonary diseases |
| J84.9 | Interstitial pulmonary disease, unspecified |
| R04.2 | Hemoptysis |
| R05.1 | Acute cough |
| R05.2 | Subacute cough |
| R06.02 | Shortness of breath |
| R06.03 | Acute respiratory distress |
| R06.1 | Stridor |
| R06.2 | Wheezing |
| R06.82 | Tachypnea, not elsewhere classified |
| R07.1 | Chest pain on breathing |
| R07.81 | Pleurodynia |
| R09.02 | Hypoxemia |
| R09.1 | Pleurisy |
| R43.0 | Anosmia |
| R43.9 | Unspecified disturbances of smell and taste |
| R50.81 | Fever presenting with conditions classified elsewhere |
| R50.9 | Fever, unspecified |
| R53.1 | Weakness |
| R55 | Syncope and collapse |
| R68.83 | Chills (without fever) |
| R79.81 | Abnormal blood-gas level |
| U07.1 | COVID-19 |
| Z03.818 | Encounter for observation for suspected exposure to other biological agents ruled out |
| Z20.822 | Contact with and (suspected) exposure to COVID-19 |
| Z20.828 | Contact with and (suspected) exposure to other viral communicable diseases |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 87428?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 193 ICD-10 diagnosis codes that support medical necessity for CPT 87428. 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 87428 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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