CPT 91113: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 91113 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 91113 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 |
|---|---|
| K63.5 | Polyp of colon |
| K92.1 | Melena |
| K92.2 | Gastrointestinal hemorrhage, unspecified |
| R19.5 | Other fecal abnormalities |
| Z53.09 | Procedure and treatment not carried out because of other contraindication |
| Z53.8 | Procedure and treatment not carried out for other reasons |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 91113?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 6 ICD-10 diagnosis codes that support medical necessity for CPT 91113. 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 91113 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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