CPT 98928: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 98928 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 98928 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 |
|---|---|
| M99.00 | Segmental and somatic dysfunction of head region |
| M99.01 | Segmental and somatic dysfunction of cervical region |
| M99.02 | Segmental and somatic dysfunction of thoracic region |
| M99.03 | Segmental and somatic dysfunction of lumbar region |
| M99.04 | Segmental and somatic dysfunction of sacral region |
| M99.05 | Segmental and somatic dysfunction of pelvic region |
| M99.06 | Segmental and somatic dysfunction of lower extremity |
| M99.07 | Segmental and somatic dysfunction of upper extremity |
| M99.08 | Segmental and somatic dysfunction of rib cage |
| M99.09 | Segmental and somatic dysfunction of abdomen and other regions |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 98928?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 10 ICD-10 diagnosis codes that support medical necessity for CPT 98928. 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 98928 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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