ICD↔CPT crosswalk
CPT 99291: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 99291 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 99291 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 |
|---|---|
| A15.0 | Tuberculosis of lung |
| A22.1 | Pulmonary anthrax |
| A37.01 | Whooping cough due to Bordetella pertussis with pneumonia |
| A37.11 | Whooping cough due to Bordetella parapertussis with pneumonia |
| A37.81 | Whooping cough due to other Bordetella species with pneumonia |
| A37.91 | Whooping cough, unspecified species with pneumonia |
| A48.1 | Legionnaires' disease |
| B25.0 | Cytomegaloviral pneumonitis |
| B44.0 | Invasive pulmonary aspergillosis |
| B77.81 | Ascariasis pneumonia |
| C34.11 | Malignant neoplasm of upper lobe, right bronchus or lung |
| C34.12 | Malignant neoplasm of upper lobe, left bronchus or lung |
| C34.2 | Malignant neoplasm of middle lobe, bronchus or lung |
| C34.31 | Malignant neoplasm of lower lobe, right bronchus or lung |
| C34.32 | Malignant neoplasm of lower lobe, left bronchus or lung |
| C34.80 | Malignant neoplasm of overlapping sites of unspecified bronchus and lung |
| C34.81 | Malignant neoplasm of overlapping sites of right bronchus and lung |
| C34.82 | Malignant neoplasm of overlapping sites of left bronchus and lung |
| C34.91 | Malignant neoplasm of unspecified part of right bronchus or lung |
| C34.92 | Malignant neoplasm of unspecified part of left bronchus or lung |
| C38.4 | Malignant neoplasm of pleura |
| C45.0 | Mesothelioma of pleura |
| C78.01 | Secondary malignant neoplasm of right lung |
| C78.02 | Secondary malignant neoplasm of left lung |
| C78.2 | Secondary malignant neoplasm of pleura |
| C78.39 | Secondary malignant neoplasm of other respiratory organs |
| E84.0 | Cystic fibrosis with pulmonary manifestations |
| E84.8 | Cystic fibrosis with other manifestations |
| E84.9 | Cystic fibrosis, unspecified |
| F51.19 | Other hypersomnia not due to a substance or known physiological condition |
| G47.01 | Insomnia due to medical condition |
| G47.09 | Other insomnia |
| G47.10 | Hypersomnia, unspecified |
| G47.11 | Idiopathic hypersomnia with long sleep time |
| G47.12 | Idiopathic hypersomnia without long sleep time |
| G47.13 | Recurrent hypersomnia |
| G47.14 | Hypersomnia due to medical condition |
| G47.19 | Other hypersomnia |
| G47.20 | Circadian rhythm sleep disorder, unspecified type |
| G47.21 | Circadian rhythm sleep disorder, delayed sleep phase type |
| G47.22 | Circadian rhythm sleep disorder, advanced sleep phase type |
| G47.23 | Circadian rhythm sleep disorder, irregular sleep wake type |
| G47.24 | Circadian rhythm sleep disorder, free running type |
| G47.25 | Circadian rhythm sleep disorder, jet lag type |
| G47.26 | Circadian rhythm sleep disorder, shift work type |
| G47.27 | Circadian rhythm sleep disorder in conditions classified elsewhere |
| G47.29 | Other circadian rhythm sleep disorder |
| G47.30 | Sleep apnea, unspecified |
| G47.31 | Primary central sleep apnea |
| G47.32 | High altitude periodic breathing |
| G47.33 | Obstructive sleep apnea (adult) (pediatric) |
| G47.34 | Idiopathic sleep related nonobstructive alveolar hypoventilation |
| G47.35 | Congenital central alveolar hypoventilation syndrome |
| G47.36 | Sleep related hypoventilation in conditions classified elsewhere |
| G47.37 | Central sleep apnea in conditions classified elsewhere |
| G47.39 | Other sleep apnea |
| G47.50 | Parasomnia, unspecified |
| G47.51 | Confusional arousals |
| G47.52 | REM sleep behavior disorder |
| G47.53 | Recurrent isolated sleep paralysis |
| G47.54 | Parasomnia in conditions classified elsewhere |
| G47.59 | Other parasomnia |
| G47.69 | Other sleep related movement disorders |
| G47.8 | Other sleep disorders |
| I09.81 | Rheumatic heart failure |
| I11.0 | Hypertensive heart disease with heart failure |
| I26.01 | Septic pulmonary embolism with acute cor pulmonale |
| I26.02 | Saddle embolus of pulmonary artery with acute cor pulmonale |
| I26.03 | Cement embolism of pulmonary artery with acute cor pulmonale |
| I26.04 | Fat embolism of pulmonary artery with acute cor pulmonale |
| I26.09 | Other pulmonary embolism with acute cor pulmonale |
| I26.90 | Septic pulmonary embolism without acute cor pulmonale |
| I26.92 | Saddle embolus of pulmonary artery without acute cor pulmonale |
| I26.93 | Single subsegmental thrombotic pulmonary embolism without acute cor pulmonale |
| I26.94 | Multiple subsegmental thrombotic pulmonary emboli without acute cor pulmonale |
| I26.95 | Cement embolism of pulmonary artery without acute cor pulmonale |
| I26.96 | Fat embolism of pulmonary artery without acute cor pulmonale |
| I26.99 | Other pulmonary embolism without acute cor pulmonale |
| I27.0 | Primary pulmonary hypertension |
| I27.20 | Pulmonary hypertension, unspecified |
| I27.21 | Secondary pulmonary arterial hypertension |
| I27.22 | Pulmonary hypertension due to left heart disease |
| I27.23 | Pulmonary hypertension due to lung diseases and hypoxia |
| I27.24 | Chronic thromboembolic pulmonary hypertension |
| I27.29 | Other secondary pulmonary hypertension |
| I27.81 | Cor pulmonale (chronic) |
| I27.82 | Chronic pulmonary embolism |
| I27.83 | Eisenmenger's syndrome |
| I27.840 | Fontan-associated liver disease [FALD] |
| I27.841 | Fontan-associated lymphatic dysfunction |
| I27.848 | Other Fontan-associated condition |
| I27.849 | Fontan related circulation, unspecified |
| I27.89 | Other specified pulmonary heart diseases |
| I27.9 | Pulmonary heart disease, unspecified |
| I50.1 | Left ventricular failure, unspecified |
| I50.20 | Unspecified systolic (congestive) heart failure |
| I50.21 | Acute systolic (congestive) heart failure |
| I50.22 | Chronic systolic (congestive) heart failure |
| I50.23 | Acute on chronic systolic (congestive) heart failure |
| I50.30 | Unspecified diastolic (congestive) heart failure |
| I50.31 | Acute diastolic (congestive) heart failure |
| I50.32 | Chronic diastolic (congestive) heart failure |
| I50.33 | Acute on chronic diastolic (congestive) heart failure |
| I50.40 | Unspecified combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.41 | Acute combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.42 | Chronic combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.43 | Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.810 | Right heart failure, unspecified |
| I50.811 | Acute right heart failure |
| I50.812 | Chronic right heart failure |
| I50.813 | Acute on chronic right heart failure |
| I50.814 | Right heart failure due to left heart failure |
| I50.82 | Biventricular heart failure |
| I50.83 | High output heart failure |
| I50.84 | End stage heart failure |
| I50.89 | Other heart failure |
| I50.9 | Heart failure, unspecified |
| I78.0 | Hereditary hemorrhagic telangiectasia |
| J04.10 | Acute tracheitis without obstruction |
| J04.11 | Acute tracheitis with obstruction |
| J04.2 | Acute laryngotracheitis |
| J05.0 | Acute obstructive laryngitis [croup] |
| J05.10 | Acute epiglottitis without obstruction |
| J05.11 | Acute epiglottitis with obstruction |
| J10.00 | Influenza due to other identified influenza virus with unspecified type of pneumonia |
| J10.08 | Influenza due to other identified influenza virus with other specified pneumonia |
| J11.00 | Influenza due to unidentified influenza virus with unspecified type of pneumonia |
| J11.08 | Influenza due to unidentified influenza virus with specified pneumonia |
| J12.0 | Adenoviral pneumonia |
| J12.1 | Respiratory syncytial virus pneumonia |
| J12.2 | Parainfluenza virus pneumonia |
| J12.3 | Human metapneumovirus pneumonia |
| J12.81 | Pneumonia due to SARS-associated coronavirus |
| J12.82 | Pneumonia due to coronavirus disease 2019 |
| J12.89 | Other viral pneumonia |
| J12.9 | Viral pneumonia, unspecified |
| J14 | Pneumonia due to Hemophilus influenzae |
| J15.0 | Pneumonia due to Klebsiella pneumoniae |
| J15.1 | Pneumonia due to Pseudomonas |
| J15.20 | Pneumonia due to staphylococcus, unspecified |
| J15.211 | Pneumonia due to Methicillin susceptible Staphylococcus aureus |
| J15.212 | Pneumonia due to Methicillin resistant Staphylococcus aureus |
| J15.29 | Pneumonia due to other staphylococcus |
| J15.3 | Pneumonia due to streptococcus, group B |
| J15.4 | Pneumonia due to other streptococci |
| J15.5 | Pneumonia due to Escherichia coli |
| J15.69 | Pneumonia due to other Gram-negative bacteria |
| J15.7 | Pneumonia due to Mycoplasma pneumoniae |
| J15.8 | Pneumonia due to other specified bacteria |
| J15.9 | Unspecified bacterial pneumonia |
| J16.0 | Chlamydial pneumonia |
| J16.8 | Pneumonia due to other specified infectious organisms |
| J17 | Pneumonia in diseases classified elsewhere |
| J18.0 | Bronchopneumonia, unspecified organism |
| J18.8 | Other pneumonia, unspecified organism |
| J18.9 | Pneumonia, unspecified organism |
| J20.0 | Acute bronchitis due to Mycoplasma pneumoniae |
| J20.1 | Acute bronchitis due to Hemophilus influenzae |
| J20.2 | Acute bronchitis due to streptococcus |
| J20.3 | Acute bronchitis due to coxsackievirus |
| J20.4 | Acute bronchitis due to parainfluenza virus |
| J20.5 | Acute bronchitis due to respiratory syncytial virus |
| J20.6 | Acute bronchitis due to rhinovirus |
| J20.7 | Acute bronchitis due to echovirus |
| J20.8 | Acute bronchitis due to other specified organisms |
| J20.9 | Acute bronchitis, unspecified |
| J21.0 | Acute bronchiolitis due to respiratory syncytial virus |
| J21.1 | Acute bronchiolitis due to human metapneumovirus |
| J21.8 | Acute bronchiolitis due to other specified organisms |
| J21.9 | Acute bronchiolitis, unspecified |
| J39.8 | Other specified diseases of upper respiratory tract |
| J41.0 | Simple chronic bronchitis |
| J41.1 | Mucopurulent chronic bronchitis |
| J41.8 | Mixed simple and mucopurulent chronic bronchitis |
| J42 | Unspecified chronic bronchitis |
| J43.0 | Unilateral pulmonary emphysema [MacLeod's syndrome] |
| J43.1 | Panlobular emphysema |
| J43.2 | Centrilobular emphysema |
| J43.8 | Other emphysema |
| J43.9 | Emphysema, unspecified |
| J44.0 | Chronic obstructive pulmonary disease with (acute) lower respiratory infection |
| J44.1 | Chronic obstructive pulmonary disease with (acute) exacerbation |
| J44.9 | Chronic obstructive pulmonary disease, unspecified |
| J45.20 | Mild intermittent asthma, uncomplicated |
| J45.21 | Mild intermittent asthma with (acute) exacerbation |
| J45.22 | Mild intermittent asthma with status asthmaticus |
| J45.30 | Mild persistent asthma, uncomplicated |
| J45.31 | Mild persistent asthma with (acute) exacerbation |
| J45.32 | Mild persistent asthma with status asthmaticus |
| J45.40 | Moderate persistent asthma, uncomplicated |
| J45.41 | Moderate persistent asthma with (acute) exacerbation |
| J45.42 | Moderate persistent asthma with status asthmaticus |
| J45.50 | Severe persistent asthma, uncomplicated |
| J45.51 | Severe persistent asthma with (acute) exacerbation |
| J45.52 | Severe persistent asthma with status asthmaticus |
| J45.901 | Unspecified asthma with (acute) exacerbation |
| J45.902 | Unspecified asthma with status asthmaticus |
| J45.909 | Unspecified asthma, uncomplicated |
| J45.990 | Exercise induced bronchospasm |
| J45.991 | Cough variant asthma |
| J45.998 | Other asthma |
| J47.0 | Bronchiectasis with acute lower respiratory infection |
| J47.1 | Bronchiectasis with (acute) exacerbation |
| J47.9 | Bronchiectasis, uncomplicated |
| J60 | Coalworker's pneumoconiosis |
| J61 | Pneumoconiosis due to asbestos and other mineral fibers |
| J62.0 | Pneumoconiosis due to talc dust |
| J62.8 | Pneumoconiosis due to other dust containing silica |
| J63.0 | Aluminosis (of lung) |
| J63.1 | Bauxite fibrosis (of lung) |
| J63.2 | Berylliosis |
| J63.3 | Graphite fibrosis (of lung) |
| J63.4 | Siderosis |
| J63.5 | Stannosis |
| J63.6 | Pneumoconiosis due to other specified inorganic dusts |
| J64 | Unspecified pneumoconiosis |
| J65 | Pneumoconiosis associated with tuberculosis |
| J66.0 | Byssinosis |
| J66.1 | Flax-dressers' disease |
| J66.2 | Cannabinosis |
| J66.8 | Airway disease due to other specific organic dusts |
| J67.0 | Farmer's lung |
| J67.1 | Bagassosis |
| J67.2 | Bird fancier's lung |
| J67.3 | Suberosis |
| J67.4 | Maltworker's lung |
| J67.5 | Mushroom-worker's lung |
| J67.6 | Maple-bark-stripper's lung |
| J67.7 | Air conditioner and humidifier lung |
| J67.8 | Hypersensitivity pneumonitis due to other organic dusts |
| J67.9 | Hypersensitivity pneumonitis due to unspecified organic dust |
| J68.0 | Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors |
| J68.4 | Chronic respiratory conditions due to chemicals, gases, fumes and vapors |
| J68.8 | Other respiratory conditions due to chemicals, gases, fumes and vapors |
| J68.9 | Unspecified respiratory condition due to chemicals, gases, fumes and vapors |
| J69.0 | Pneumonitis due to inhalation of food and vomit |
| J70.1 | Chronic and other pulmonary manifestations due to radiation |
| J70.5 | Respiratory conditions due to smoke inhalation |
| J80 | Acute respiratory distress syndrome |
| J82.81 | Chronic eosinophilic pneumonia |
| J82.82 | Acute eosinophilic pneumonia |
| J82.83 | Eosinophilic asthma |
| J84.10 | Pulmonary fibrosis, unspecified |
| J84.111 | Idiopathic interstitial pneumonia, not otherwise specified |
| J84.112 | Idiopathic pulmonary fibrosis |
| J84.113 | Idiopathic non-specific interstitial pneumonitis |
| J84.114 | Acute interstitial pneumonitis |
| J84.115 | Respiratory bronchiolitis interstitial lung disease |
| J84.116 | Cryptogenic organizing pneumonia |
| J84.117 | Desquamative interstitial pneumonia |
| J84.170 | Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere |
| J84.178 | Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere |
| J84.2 | Lymphoid interstitial pneumonia |
| J84.89 | Other specified interstitial pulmonary diseases |
| J90 | Pleural effusion, not elsewhere classified |
| J91.0 | Malignant pleural effusion |
| J91.8 | Pleural effusion in other conditions classified elsewhere |
| J94.0 | Chylous effusion |
| J94.2 | Hemothorax |
| J94.8 | Other specified pleural conditions |
| J95.84 | Transfusion-related acute lung injury (TRALI) |
| J95.860 | Postprocedural hematoma of a respiratory system organ or structure following a respiratory system procedure |
| J95.861 | Postprocedural hematoma of a respiratory system organ or structure following other procedure |
| J95.862 | Postprocedural seroma of a respiratory system organ or structure following a respiratory system procedure |
| J95.863 | Postprocedural seroma of a respiratory system organ or structure following other procedure |
| J95.87 | Transfusion-associated dyspnea (TAD) |
| J98.01 | Acute bronchospasm |
| J98.09 | Other diseases of bronchus, not elsewhere classified |
| J98.11 | Atelectasis |
| J98.19 | Other pulmonary collapse |
| J98.2 | Interstitial emphysema |
| J98.4 | Other disorders of lung |
| J98.51 | Mediastinitis |
| J98.59 | Other diseases of mediastinum, not elsewhere classified |
| M05.10 | Rheumatoid lung disease with rheumatoid arthritis of unspecified site |
| M05.111 | Rheumatoid lung disease with rheumatoid arthritis of right shoulder |
| M05.112 | Rheumatoid lung disease with rheumatoid arthritis of left shoulder |
| M05.121 | Rheumatoid lung disease with rheumatoid arthritis of right elbow |
| M05.122 | Rheumatoid lung disease with rheumatoid arthritis of left elbow |
| M05.131 | Rheumatoid lung disease with rheumatoid arthritis of right wrist |
| M05.132 | Rheumatoid lung disease with rheumatoid arthritis of left wrist |
| M05.141 | Rheumatoid lung disease with rheumatoid arthritis of right hand |
| M05.142 | Rheumatoid lung disease with rheumatoid arthritis of left hand |
| M05.151 | Rheumatoid lung disease with rheumatoid arthritis of right hip |
| M05.152 | Rheumatoid lung disease with rheumatoid arthritis of left hip |
| M05.161 | Rheumatoid lung disease with rheumatoid arthritis of right knee |
| M05.162 | Rheumatoid lung disease with rheumatoid arthritis of left knee |
| M05.171 | Rheumatoid lung disease with rheumatoid arthritis of right ankle and foot |
| M05.172 | Rheumatoid lung disease with rheumatoid arthritis of left ankle and foot |
| M05.19 | Rheumatoid lung disease with rheumatoid arthritis of multiple sites |
| Q25.72 | Congenital pulmonary arteriovenous malformation |
| Q33.4 | Congenital bronchiectasis |
| R05.1 | Acute cough |
| R05.2 | Subacute cough |
| R06.00 | Dyspnea, unspecified |
| R06.03 | Acute respiratory distress |
| R06.09 | Other forms of dyspnea |
| R06.2 | Wheezing |
| R06.89 | Other abnormalities of breathing |
| R09.01 | Asphyxia |
| R09.02 | Hypoxemia |
| R09.89 | Other specified symptoms and signs involving the circulatory and respiratory systems |
| R23.0 | Cyanosis |
| R40.0 | Somnolence |
| R40.1 | Stupor |
| R41.0 | Disorientation, unspecified |
| R41.82 | Altered mental status, unspecified |
| R68.13 | Apparent life threatening event in infant (ALTE) |
| T78.2XXA | Anaphylactic shock, unspecified, initial encounter |
| T78.2XXD | Anaphylactic shock, unspecified, subsequent encounter |
| T78.2XXS | Anaphylactic shock, unspecified, sequela |
| T88.6XXA | Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter |
| T88.6XXD | Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, subsequent encounter |
| T88.6XXS | Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, sequela |
| U09.9 | Post COVID-19 condition, unspecified |
| Z85.118 | Personal history of other malignant neoplasm of bronchus and lung |
| Z85.12 | Personal history of malignant neoplasm of trachea |
| Z86.74 | Personal history of sudden cardiac arrest |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 99291?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 318 ICD-10 diagnosis codes that support medical necessity for CPT 99291. 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 99291 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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