CPT 94626: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 94626 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 94626 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 |
|---|---|
| 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 |
| J44.81 | Bronchiolitis obliterans and bronchiolitis obliterans syndrome |
| J44.89 | Other specified chronic obstructive pulmonary disease |
| J44.9 | Chronic obstructive pulmonary disease, unspecified |
| U09.9 | Post COVID-19 condition, unspecified |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 94626?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 12 ICD-10 diagnosis codes that support medical necessity for CPT 94626. 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 94626 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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