CPT 90999: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 90999 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 90999 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 |
|---|---|
| E83.30 | Disorder of phosphorus metabolism, unspecified |
| E83.39 | Other disorders of phosphorus metabolism |
| E87.20 | Acidosis, unspecified |
| E87.21 | Acute metabolic acidosis |
| E87.22 | Chronic metabolic acidosis |
| E87.29 | Other acidosis |
| E87.5 | Hyperkalemia |
| E87.70 | Fluid overload, unspecified |
| E87.71 | Transfusion associated circulatory overload |
| E87.79 | Other fluid overload |
| I30.0 | Acute nonspecific idiopathic pericarditis |
| I30.1 | Infective pericarditis |
| I30.8 | Other forms of acute pericarditis |
| I30.9 | Acute pericarditis, unspecified |
| I32 | Pericarditis in diseases classified elsewhere |
| I50.1 | Left ventricular failure, unspecified |
| I50.20 | Unspecified systolic (congestive) heart failure |
| I50.21 | Acute systolic (congestive) heart failure |
| I50.22 | Chronic systolic (congestive) heart failure |
| I50.23 | Acute on chronic systolic (congestive) heart failure |
| I50.30 | Unspecified diastolic (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 |
| I50.40 | Unspecified combined systolic (congestive) and 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 |
| I50.810 | Right heart failure, unspecified |
| 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 |
| I50.9 | Heart failure, unspecified |
| I77.0 | Arteriovenous fistula, acquired |
| I95.3 | Hypotension of hemodialysis |
| J81.0 | Acute pulmonary edema |
| M32.12 | Pericarditis in systemic lupus erythematosus |
| N25.81 | Secondary hyperparathyroidism of renal origin |
| 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 |
| O09.891 | 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 |
| R60.1 | Generalized edema |
| R63.5 | Abnormal weight gain |
| T82.898A | Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter |
| T82.898D | Other specified complication of vascular prosthetic devices, implants and grafts, subsequent encounter |
| T82.898S | Other specified complication of vascular prosthetic devices, implants and grafts, sequela |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 90999?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 56 ICD-10 diagnosis codes that support medical necessity for CPT 90999. 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 90999 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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