CPT G0540: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT G0540 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT G0540 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 |
| G11.5 | Hypomyelination - hypogonadotropic hypogonadism - hypodontia |
| G30.0 | Alzheimer's disease with early onset |
| G30.1 | Alzheimer's disease with late onset |
| G30.8 | Other Alzheimer's disease |
| G30.9 | Alzheimer's disease, unspecified |
| G31.01 | Pick's disease |
| G31.1 | Senile degeneration of brain, not elsewhere classified |
| G31.80 | Leukodystrophy, unspecified |
| G31.85 | Corticobasal degeneration |
| G31.86 | Alexander disease |
| G31.87 | Primary progressive apraxia of speech |
| G37.89 | Other specified demyelinating diseases of central nervous system |
| R41.85 | Anosognosia |
| R48.1 | Agnosia |
| R48.2 | Apraxia |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT G0540?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 21 ICD-10 diagnosis codes that support medical necessity for CPT G0540. 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 G0540 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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