Date Posted: June 25, 2026

This Billing and Coding article has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, NMI), and 01312 (NV).

Effective Date: July 1, 2026

Summary of Article Changes:

Revision Effective Date: 07/01/2026

Removed coding guidance in Article Text section as all coding guidance is in the applicable tables.

Deleted the following ICD-10 Code: N85.00

Added the following ICD-10 Codes to Group 1: N84.0, N92.0, N92.1, N92.4, N95.0

Added the following to Group 1 Paragraph: Dual diagnosis required. Must bill Group 2 diagnosis with any of the diagnosis codes in Group 1.

Moved the following ICD-10 Code from Group 1 to Group 2: N85.01

Added the following ICD-10 Codes to Group 2: N85.02

Added the following Group 2: Medical Necessity ICD-10-CM Codes Asterisk Explanation: Codes listed with an asterisk (*) are only to be used if beneficiary is not a surgical candidate.

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