ICD↔CPT crosswalk
CPT 91125: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 91125 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 91125 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 |
|---|---|
| G04.1 | Tropical spastic paraplegia |
| G35.A | Relapsing-remitting multiple sclerosis |
| G35.B0 | Primary progressive multiple sclerosis, unspecified |
| G35.B1 | Active primary progressive multiple sclerosis |
| G35.B2 | Non-active primary progressive multiple sclerosis |
| G35.C0 | Secondary progressive multiple sclerosis, unspecified |
| G35.C1 | Active secondary progressive multiple sclerosis |
| G35.C2 | Non-active secondary progressive multiple sclerosis |
| G81.01 | Flaccid hemiplegia affecting right dominant side |
| G81.02 | Flaccid hemiplegia affecting left dominant side |
| G81.03 | Flaccid hemiplegia affecting right nondominant side |
| G81.04 | Flaccid hemiplegia affecting left nondominant side |
| G81.11 | Spastic hemiplegia affecting right dominant side |
| G81.12 | Spastic hemiplegia affecting left dominant side |
| G81.13 | Spastic hemiplegia affecting right nondominant side |
| G81.14 | Spastic hemiplegia affecting left nondominant side |
| G81.91 | Hemiplegia, unspecified affecting right dominant side |
| G81.92 | Hemiplegia, unspecified affecting left dominant side |
| G81.93 | Hemiplegia, unspecified affecting right nondominant side |
| G81.94 | Hemiplegia, unspecified affecting left nondominant side |
| G82.20 | Paraplegia, unspecified |
| G82.21 | Paraplegia, complete |
| G82.22 | Paraplegia, incomplete |
| G82.51 | Quadriplegia, C1-C4 complete |
| G82.52 | Quadriplegia, C1-C4 incomplete |
| G82.53 | Quadriplegia, C5-C7 complete |
| G82.54 | Quadriplegia, C5-C7 incomplete |
| G83.0 | Diplegia of upper limbs |
| G83.11 | Monoplegia of lower limb affecting right dominant side |
| G83.12 | Monoplegia of lower limb affecting left dominant side |
| G83.13 | Monoplegia of lower limb affecting right nondominant side |
| G83.14 | Monoplegia of lower limb affecting left nondominant side |
| G83.21 | Monoplegia of upper limb affecting right dominant side |
| G83.22 | Monoplegia of upper limb affecting left dominant side |
| G83.23 | Monoplegia of upper limb affecting right nondominant side |
| G83.24 | Monoplegia of upper limb affecting left nondominant side |
| G83.31 | Monoplegia, unspecified affecting right dominant side |
| G83.32 | Monoplegia, unspecified affecting left dominant side |
| G83.33 | Monoplegia, unspecified affecting right nondominant side |
| G83.34 | Monoplegia, unspecified affecting left nondominant side |
| G83.4 | Cauda equina syndrome |
| I67.89 | Other cerebrovascular disease |
| K59.01 | Slow transit constipation |
| K59.02 | Outlet dysfunction constipation |
| K59.04 | Chronic idiopathic constipation |
| K59.09 | Other constipation |
| K59.4 | Anal spasm |
| K62.3 | Rectal prolapse |
| K62.6 | Ulcer of anus and rectum |
| M25.78 | Osteophyte, vertebrae |
| M47.011 | Anterior spinal artery compression syndromes, occipito-atlanto-axial region |
| M47.012 | Anterior spinal artery compression syndromes, cervical region |
| M47.013 | Anterior spinal artery compression syndromes, cervicothoracic region |
| M47.014 | Anterior spinal artery compression syndromes, thoracic region |
| M47.015 | Anterior spinal artery compression syndromes, thoracolumbar region |
| M47.016 | Anterior spinal artery compression syndromes, lumbar region |
| M47.021 | Vertebral artery compression syndromes, occipito-atlanto-axial region |
| M47.022 | Vertebral artery compression syndromes, cervical region |
| M47.11 | Other spondylosis with myelopathy, occipito-atlanto-axial region |
| M47.12 | Other spondylosis with myelopathy, cervical region |
| M47.13 | Other spondylosis with myelopathy, cervicothoracic region |
| M47.14 | Other spondylosis with myelopathy, thoracic region |
| M47.15 | Other spondylosis with myelopathy, thoracolumbar region |
| M47.16 | Other spondylosis with myelopathy, lumbar region |
| M47.21 | Other spondylosis with radiculopathy, occipito-atlanto-axial region |
| M47.22 | Other spondylosis with radiculopathy, cervical region |
| M47.23 | Other spondylosis with radiculopathy, cervicothoracic region |
| M47.24 | Other spondylosis with radiculopathy, thoracic region |
| M47.25 | Other spondylosis with radiculopathy, thoracolumbar region |
| M47.26 | Other spondylosis with radiculopathy, lumbar region |
| M47.27 | Other spondylosis with radiculopathy, lumbosacral region |
| M47.28 | Other spondylosis with radiculopathy, sacral and sacrococcygeal region |
| M47.811 | Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region |
| M47.812 | Spondylosis without myelopathy or radiculopathy, cervical region |
| M47.813 | Spondylosis without myelopathy or radiculopathy, cervicothoracic region |
| M47.814 | Spondylosis without myelopathy or radiculopathy, thoracic region |
| M47.815 | Spondylosis without myelopathy or radiculopathy, thoracolumbar region |
| M47.816 | Spondylosis without myelopathy or radiculopathy, lumbar region |
| M47.817 | Spondylosis without myelopathy or radiculopathy, lumbosacral region |
| M47.818 | Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region |
| M48.11 | Ankylosing hyperostosis [Forestier], occipito-atlanto-axial region |
| M48.12 | Ankylosing hyperostosis [Forestier], cervical region |
| M48.13 | Ankylosing hyperostosis [Forestier], cervicothoracic region |
| M48.14 | Ankylosing hyperostosis [Forestier], thoracic region |
| M48.15 | Ankylosing hyperostosis [Forestier], thoracolumbar region |
| M48.16 | Ankylosing hyperostosis [Forestier], lumbar region |
| M48.17 | Ankylosing hyperostosis [Forestier], lumbosacral region |
| M48.18 | Ankylosing hyperostosis [Forestier], sacral and sacrococcygeal region |
| M48.19 | Ankylosing hyperostosis [Forestier], multiple sites in spine |
| M48.21 | Kissing spine, occipito-atlanto-axial region |
| M48.22 | Kissing spine, cervical region |
| M48.23 | Kissing spine, cervicothoracic region |
| M48.24 | Kissing spine, thoracic region |
| M48.25 | Kissing spine, thoracolumbar region |
| M48.26 | Kissing spine, lumbar region |
| M48.27 | Kissing spine, lumbosacral region |
| M48.31 | Traumatic spondylopathy, occipito-atlanto-axial region |
| M48.32 | Traumatic spondylopathy, cervical region |
| M48.33 | Traumatic spondylopathy, cervicothoracic region |
| M48.34 | Traumatic spondylopathy, thoracic region |
| M48.35 | Traumatic spondylopathy, thoracolumbar region |
| M48.36 | Traumatic spondylopathy, lumbar region |
| M48.37 | Traumatic spondylopathy, lumbosacral region |
| M48.38 | Traumatic spondylopathy, sacral and sacrococcygeal region |
| N30.10 | Interstitial cystitis (chronic) without hematuria |
| N30.11 | Interstitial cystitis (chronic) with hematuria |
| N31.0 | Uninhibited neuropathic bladder, not elsewhere classified |
| N31.1 | Reflex neuropathic bladder, not elsewhere classified |
| N31.2 | Flaccid neuropathic bladder, not elsewhere classified |
| N31.8 | Other neuromuscular dysfunction of bladder |
| N36.42 | Intrinsic sphincter deficiency (ISD) |
| N36.43 | Combined hypermobility of urethra and intrinsic sphincter deficiency |
| N36.44 | Muscular disorders of urethra |
| N36.8 | Other specified disorders of urethra |
| N39.3 | Stress incontinence (female) (male) |
| N39.41 | Urge incontinence |
| N39.42 | Incontinence without sensory awareness |
| N39.43 | Post-void dribbling |
| N39.44 | Nocturnal enuresis |
| N39.45 | Continuous leakage |
| N39.46 | Mixed incontinence |
| N39.490 | Overflow incontinence |
| N39.491 | Coital incontinence |
| N39.492 | Postural (urinary) incontinence |
| N39.498 | Other specified urinary incontinence |
| R15.0 | Incomplete defecation |
| R15.1 | Fecal smearing |
| R15.2 | Fecal urgency |
| R15.9 | Full incontinence of feces |
| R19.8 | Other specified symptoms and signs involving the digestive system and abdomen |
| R33.0 | Drug induced retention of urine |
| R33.8 | Other retention of urine |
| R35.0 | Frequency of micturition |
| R39.14 | Feeling of incomplete bladder emptying |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 91125?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 134 ICD-10 diagnosis codes that support medical necessity for CPT 91125. 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 91125 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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