ICD↔CPT crosswalk
CPT 99242: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 99242 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 99242 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 |
|---|---|
| F01.50 | Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F01.A0 | Vascular dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F01.A11 | Vascular dementia, mild, with agitation |
| F01.A18 | Vascular dementia, mild, with other behavioral disturbance |
| F01.A2 | Vascular dementia, mild, with psychotic disturbance |
| F01.A3 | Vascular dementia, mild, with mood disturbance |
| F01.A4 | Vascular dementia, mild, with anxiety |
| F01.B0 | Vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F01.B11 | Vascular dementia, moderate, with agitation |
| F01.B18 | Vascular dementia, moderate, with other behavioral disturbance |
| F01.B2 | Vascular dementia, moderate, with psychotic disturbance |
| F01.B3 | Vascular dementia, moderate, with mood disturbance |
| F01.B4 | Vascular dementia, moderate, with anxiety |
| F01.C0 | Vascular dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F01.C11 | Vascular dementia, severe, with agitation |
| F01.C18 | Vascular dementia, severe, with other behavioral disturbance |
| F01.C2 | Vascular dementia, severe, with psychotic disturbance |
| F01.C3 | Vascular dementia, severe, with mood disturbance |
| F01.C4 | Vascular dementia, severe, with anxiety |
| F02.80 | Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F02.A0 | Dementia in other diseases classified elsewhere, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F02.A11 | Dementia in other diseases classified elsewhere, mild, with agitation |
| F02.A18 | Dementia in other diseases classified elsewhere, mild, with other behavioral disturbance |
| F02.A2 | Dementia in other diseases classified elsewhere, mild, with psychotic disturbance |
| F02.A3 | Dementia in other diseases classified elsewhere, mild, with mood disturbance |
| F02.A4 | Dementia in other diseases classified elsewhere, mild, with anxiety |
| F02.B0 | Dementia in other diseases classified elsewhere, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F02.B11 | Dementia in other diseases classified elsewhere, moderate, with agitation |
| F02.B18 | Dementia in other diseases classified elsewhere, moderate, with other behavioral disturbance |
| F02.B2 | Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance |
| F02.B3 | Dementia in other diseases classified elsewhere, moderate, with mood disturbance |
| F02.B4 | Dementia in other diseases classified elsewhere, moderate, with anxiety |
| F02.C0 | Dementia in other diseases classified elsewhere, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F02.C11 | Dementia in other diseases classified elsewhere, severe, with agitation |
| F02.C18 | Dementia in other diseases classified elsewhere, severe, with other behavioral disturbance |
| F02.C2 | Dementia in other diseases classified elsewhere, severe, with psychotic disturbance |
| F02.C3 | Dementia in other diseases classified elsewhere, severe, with mood disturbance |
| F02.C4 | Dementia in other diseases classified elsewhere, severe, with anxiety |
| F03.90 | Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F03.911 | Unspecified dementia, unspecified severity, with agitation |
| F03.918 | Unspecified dementia, unspecified severity, with other behavioral disturbance |
| F03.92 | Unspecified dementia, unspecified severity, with psychotic disturbance |
| F03.93 | Unspecified dementia, unspecified severity, with mood disturbance |
| F03.94 | Unspecified dementia, unspecified severity, with anxiety |
| F03.A0 | Unspecified dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F03.A11 | Unspecified dementia, mild, with agitation |
| F03.A18 | Unspecified dementia, mild, with other behavioral disturbance |
| F03.A2 | Unspecified dementia, mild, with psychotic disturbance |
| F03.A3 | Unspecified dementia, mild, with mood disturbance |
| F03.A4 | Unspecified dementia, mild, with anxiety |
| F03.B0 | Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F03.B11 | Unspecified dementia, moderate, with agitation |
| F03.B18 | Unspecified dementia, moderate, with other behavioral disturbance |
| F03.B2 | Unspecified dementia, moderate, with psychotic disturbance |
| F03.B3 | Unspecified dementia, moderate, with mood disturbance |
| F03.B4 | Unspecified dementia, moderate, with anxiety |
| F03.C0 | Unspecified dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety |
| F03.C11 | Unspecified dementia, severe, with agitation |
| F03.C18 | Unspecified dementia, severe, with other behavioral disturbance |
| F03.C2 | Unspecified dementia, severe, with psychotic disturbance |
| F03.C3 | Unspecified dementia, severe, with mood disturbance |
| F03.C4 | Unspecified dementia, severe, with anxiety |
| F06.70 | Mild neurocognitive disorder due to known physiological condition without behavioral disturbance |
| F06.71 | Mild neurocognitive disorder due to known physiological condition with behavioral disturbance |
| F10.27 | Alcohol dependence with alcohol-induced persisting dementia |
| F10.97 | Alcohol use, unspecified with alcohol-induced persisting dementia |
| F13.27 | Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia |
| F13.288 | Sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorder |
| F13.97 | Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia |
| F18.17 | Inhalant abuse with inhalant-induced dementia |
| F18.188 | Inhalant abuse with other inhalant-induced disorder |
| F18.27 | Inhalant dependence with inhalant-induced dementia |
| F18.288 | Inhalant dependence with other inhalant-induced disorder |
| F18.97 | Inhalant use, unspecified with inhalant-induced persisting dementia |
| F18.988 | Inhalant use, unspecified with other inhalant-induced disorder |
| F19.17 | Other psychoactive substance abuse with psychoactive substance-induced persisting dementia |
| F19.188 | Other psychoactive substance abuse with other psychoactive substance-induced disorder |
| F19.27 | Other psychoactive substance dependence with psychoactive substance-induced persisting dementia |
| F19.288 | Other psychoactive substance dependence with other psychoactive substance-induced disorder |
| F19.97 | Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia |
| F19.988 | Other psychoactive substance use, unspecified with other psychoactive substance-induced disorder |
| G10 | Huntington's disease |
| G30.0 | Alzheimer's disease with early onset |
| G30.1 | Alzheimer's disease with late onset |
| G30.8 | Other Alzheimer's disease |
| G31.01 | Pick's disease |
| G31.09 | Other frontotemporal neurocognitive disorder |
| G31.2 | Degeneration of nervous system due to alcohol |
| G31.80 | Leukodystrophy, unspecified |
| G31.83 | Neurocognitive disorder with Lewy bodies |
| G31.84 | Mild cognitive impairment of uncertain or unknown etiology |
| G31.85 | Corticobasal degeneration |
| G31.86 | Alexander disease |
| G31.87 | Primary progressive apraxia of speech |
| I69.010 | Attention and concentration deficit following nontraumatic subarachnoid hemorrhage |
| I69.011 | Memory deficit following nontraumatic subarachnoid hemorrhage |
| I69.014 | Frontal lobe and executive function deficit following nontraumatic subarachnoid hemorrhage |
| I69.015 | Cognitive social or emotional deficit following nontraumatic subarachnoid hemorrhage |
| I69.210 | Attention and concentration deficit following other nontraumatic intracranial hemorrhage |
| I69.211 | Memory deficit following other nontraumatic intracranial hemorrhage |
| I69.214 | Frontal lobe and executive function deficit following other nontraumatic intracranial hemorrhage |
| I69.215 | Cognitive social or emotional deficit following other nontraumatic intracranial hemorrhage |
| I69.310 | Attention and concentration deficit following cerebral infarction |
| I69.311 | Memory deficit following cerebral infarction |
| I69.314 | Frontal lobe and executive function deficit following cerebral infarction |
| I69.315 | Cognitive social or emotional deficit following cerebral infarction |
| I69.810 | Attention and concentration deficit following other cerebrovascular disease |
| I69.811 | Memory deficit following other cerebrovascular disease |
| I69.814 | Frontal lobe and executive function deficit following other cerebrovascular disease |
| I69.815 | Cognitive social or emotional deficit following other cerebrovascular disease |
| R41.81 | Age-related cognitive decline |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 99242?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 111 ICD-10 diagnosis codes that support medical necessity for CPT 99242. 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 99242 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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