CPT A9597: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT A9597 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT A9597 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 |
|---|---|
| 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 |
| F05 | Delirium due to known physiological condition |
| G30.9 | Alzheimer's disease, unspecified |
| G31.01 | Pick's disease |
| G31.09 | Other frontotemporal neurocognitive disorder |
| G31.1 | Senile degeneration of brain, not elsewhere classified |
| G31.9 | Degenerative disease of nervous system, unspecified |
| G40.011 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus |
| G40.019 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus |
| G40.111 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus |
| G40.119 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus |
| G40.211 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus |
| G40.219 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus |
| G40.311 | Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus |
| G40.319 | Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus |
| G40.411 | Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus |
| G40.419 | Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus |
| G40.803 | Other epilepsy, intractable, with status epilepticus |
| G40.804 | Other epilepsy, intractable, without status epilepticus |
| G40.813 | Lennox-Gastaut syndrome, intractable, with status epilepticus |
| G40.814 | Lennox-Gastaut syndrome, intractable, without status epilepticus |
| G40.823 | Epileptic spasms, intractable, with status epilepticus |
| G40.824 | Epileptic spasms, intractable, without status epilepticus |
| G40.911 | Epilepsy, unspecified, intractable, with status epilepticus |
| G40.919 | Epilepsy, unspecified, intractable, without status epilepticus |
| G40.A11 | Absence epileptic syndrome, intractable, with status epilepticus |
| G40.A19 | Absence epileptic syndrome, intractable, without status epilepticus |
| G40.B11 | Juvenile myoclonic epilepsy, intractable, with status epilepticus |
| G40.B19 | Juvenile myoclonic epilepsy, intractable, without status epilepticus |
| R41.2 | Retrograde amnesia |
| R41.3 | Other amnesia |
| R56.9 | Unspecified convulsions |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT A9597?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 55 ICD-10 diagnosis codes that support medical necessity for CPT A9597. 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 A9597 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.
Bill it right the first time
Join providers across the country delivering modern virtual care with CareNiva. Free to start, ready in minutes.
100% Satisfaction Guaranteed — try it risk-free