Downloa Form

Effective Date

Last Reviewed

Original Document

Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth the clinical evidence that the member meets the criteria for the treatment or surgical procedure. Without this documentation and information, EmblemHealth will not be able to properly review the request preauthorization or post-payment review. The clinical review criteria expressed below reflects how EmblemHealth determines whether certain services or supplies are medically necessary. This clinical policy is not intended to pre-empt the judgment of the reviewing medical director or dictate to health care providers how to practice medicine. Health care providers are expected to exercise their medical judgment in rendering appropriate care. Health care providers are expected to exercise their medical judgment in rendering appropriate care.
EmblemHealth established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). EmblemHealth expressly reserves the right to revise these conclusions as clinical information changes and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by EmblemHealth, as some programs exclude coverage for services or supplies that EmblemHealth considers medically necessary.
If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. Identification of selected brand names of devices, tests and procedures in a medical coverage policy is for reference only and is not an endorsement of any one device, test or procedure over another. In addition, coverage may be mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members. All coding and web site links are accurate at time of publication.
EmblemHealth may also use tools developed by third parties, such as the MCG™ Care Guidelines, to assist us in administering health benefits. The MCG™ Care Guidelines are intended to be used in connection with the independent professional medical judgment of a qualified health care provider and do not constitute the practice of medicine or medical advice. EmblemHealth Services Company, LLC, has adopted this policy in providing management, administrative and other services to EmblemHealth Plan, Inc., EmblemHealth Insurance Company, EmblemHealth Services Company, LLC, and Health Insurance Plan of Greater New York (HIP) related to health benefit plans offered by these entities. All of the aforementioned entities are affiliated companies under common control of EmblemHealth Inc.

Definition For the purposes of coverage by the Plan, hyperbaric oxygen therapy (HBOT) is a modality in which the entire body is exposed to pure oxygen (100%) under increased atmospheric pressure (> 1 atmospheres absolute [ATM]). The therapy is conducted in either a monoplace chamber (pure O2 delivery under pressure) or in a larger multiplace chamber (O2 delivery under pressure with compressed air where the patient receives pure O2 by mask, head tent or endotracheal tube).
HBOT has been established as the primary therapy in treating medical disorders such as carbon monoxide poisoning and gas gangrene. The therapy is also considered acceptable in treating acute vascular compromise and as adjuvant therapy in the management of disorders that are refractory to standard medical and surgical care, including acute ischemic injury, crush injuries, acute peripheral arterial insufficiency, compromised skin grafts, osteomyelitis, radiation necrosis of bone or soft tissue and cyanide poisoning.
Related Medical Guideline Topical Oxygen Wound Therapy for Medicaid/FHP members (New York State)

Page 2 of 39 Guideline Members are eligible for coverage of chamber-administered HBOT (including the one-man unit) for any of the following conditions:

Acute carbon monoxide intoxication
Decompression illness.
Air/gas embolism
Gas gangrene.
Acute traumatic peripheral ischemia.
Crush injuries and suturing of severed limbs.
Progressive necrotizing infections (necrotizing fasciitis, Meleney’s ulcer).
Acute peripheral arterial insufficiency.
Preparation and preservation of compromised skin grafts and flaps (not primary management of wounds).
Chronic refractory osteomyelitis unresponsive to conventional medical and surgical management. (Prerequisite — assessment of vascular status and correction of any vascular problems in the affected limb if possible; see Chronic refractory osteomyelitis)
Osteoradionecrosis, as an adjunct to conventional treatment (including pre- and post-treatment for dental extractions or dental surgery)
Soft tissue radionecrosis, as an adjunct to conventional treatment.
Cyanide poisoning.
Actinomycosis, as an adjunct to conventional treatment.
Diabetic wounds of the lower extremities. (Prerequisite — assessment of vascular status including objective vascular testing, and correction of any vascular problems in the affected limb if possible; see Diabetic wounds of the lower extremities)
Emergent anemia; see Emergent anemia
Idiopathic sudden sensorineural hearing loss (ISSHL) when HBOT is initiated within 3 months after onset.
Intracranial abscess; see Intracranial Abscess
Avascular necrosis (aseptic osteonecrosis)
Central retinal artery occlusion
Thermal burns, second or third degree
HBOT should not replace successful standard therapeutic measures. Depending upon the response of the member and the severity of the condition, treatment may range from < 1 week to several months. The average duration of HBOT is 2–4 weeks.
Suggested Protocols per Indication (Subject to demonstration of medical necessity; see Documentation) Actinomycosis A bacterial infection caused by Actinomyces israelii; symptoms include slow growing granulomas that later break down, discharging viscid pus-containing minute yellowish granules. Treatment includes prolonged administration of antibiotics (penicillin and tetracycline); surgical incision and draining of accessible lesions may also be helpful. Only after the disease process has been shown refractory to antibiotics and surgery could HBOT be deemed medically necessary. HBOT must be utilized as an adjunct to conventional therapy.
Acute carbon monoxide poisoning (aka carbon monoxide intoxication)

Page 3 of 39 Acute carbon monoxide poisoning induces hypoxic stress and may result in injury to the cardiac and central nervous systems. HBOT produces a higher rate of dissociation of carbon monoxide from hemoglobin than occurs at sea level pressure. Chamber-pressure should be between 2.5–3.0 ATA. Members with persistent neurological dysfunction may require subsequent treatments within 6–8hours, continuing once or twice daily until there is no further improvement in cognitive functioning.
Acute traumatic ischemia Treatment typically consists of three 1.5-hour treatment periods per day for the first 48 hours. An additional two 1.5-hour sessions per day for the next 48 hours may be also required. On days 5 and 6, one 1.5-hour session would typically be offered. Chronic refractory osteomyelitis Chronic refractory osteomyelitis persists or recurs following appropriate interventions, which include all of the following:

Antibiotic use (treatment course no < 90 days).
Abscess drainage.
Immobilization of the affected extremity.
Surgical débridements with removal of the sequestrum.
HBOT is an adjunctive therapy used with the appropriate antibiotics and surgical debridement to eliminate the dead bone. Antibiotics are chosen on the basis of bone culture and sensitivity studies.
HBOT can elevate the oxygen tensions found in infected bone to normal or above normal levels. This mechanism enhances healing and the body’s antimicrobial defenses. It is believed that HBOT augments the efficacy of certain antibiotics (gentamicin, tobramycin and amikacin). Finally, the body’s osteoclast function of removing necrotic bone is dependent upon a proper oxygen tension environment, which HBOT can provide. HBOT is typically delivered daily at a pressure of 2.0–2.5 ATA for 90–120 minutes following major debridement surgery. The number of treatments required varies on an individual basis. HBOT may be covered for members with for chronic refractory osteomyelitis who have been unresponsive to conventional medical and surgical management for three months.
Clostridial myositis and myonecrosis (gas gangrene) Gas gangrene is an acute, rapidly growing invasive infection of the muscle characterized by profound toxemia, extensive edema, massive death of tissue and variable degree of gas production. The most prevalent toxin is the alpha-toxin, which is hemolytic, tissue-necrotizing and lethal.
The diagnosis of gas gangrene is based on clinical data supported by a positive gram-stained smear or culture obtained from tissue fluids. X-ray radiographs, if obtained, can visualize tissue gas.
Onset can occur one to six hours after injury and presents with severe and sudden pain at the infected area. The skin overlying the wound progresses from shiny and tense, to dusky, then bronze in color. Hemorrhagic vesicles may be noted. A thin, sweet-odored exudate is present. Swelling and edema occur. The noncontractile muscles progress to dark red to black in color. The infection can progress as rapidly as 6 inches per hour. The goal of HBOT is to stop alpha-toxin production, thereby inhibiting further bacterial growth at which point the body can use its own host defense mechanisms.
HBOT is initiated as soon as the clinical picture presents (supported by a positive gram-stained smear) and is utilized as an adjunct to antibiotic therapy and surgery.

Page 4 of 39 Initial surgery may be limited to opening the wound. Debridement of necrotic tissue can be performed between HOBT sessions when clear demarcation between dead and viable tissue is evident. Treatment of HBOT typically consists of oxygen administered at 3.0 ATA for 90 minutes 3 times in the first 24 hours. Over the next 4–5 days, twice-daily sessions are usual. The earlier the HBOT-initiation, the better the outcome in terms of life, limb and tissue-sparing.
Compromised skin grafts HBOT typically starts at 2 treatments per day and is then reduced to 1 per day when the graft appears stable. Treatment for normal, uncompromised skin grafts or flaps is not medically necessary. Crush injuries and suturing of severed limbs, acute traumatic peripheral ischemia (ATI) and acute peripheral arterial insufficiency associated with arterial embolism and thrombosis Acute traumatic ischemia is the result of injury by external force or violence compromising circulation to an extremity. The extremity is then at risk for necrosis or amputation. Secondary complications are frequently seen and include infection, non-healing wounds and non-united fractures.
The goal of HBOT is to enhance oxygen at the tissue level to support viability. When tissue oxygen tensions fall below 30mm Hg, the body’s ability to respond to infection and wound repair is compromised. With treatment at 2–2.4 ATA, tissue oxygen tension is raised to a level such that the body’s responses can become functional again. The benefits of HBOT for this indication are:

Increased oxygen delivery per unit of blood flow or enhanced tissue oxygenation.
Edema reduction and reduction in infection complication rates, nonunion and amputation.
Treatment typically consists of three 1.5 hour periods daily for the first 48 hours. Additionally, two 1.5 hour sessions daily for the next 48 hours may be required. On days 5 and 6, one 1.5 hour session is typically given. At this point, outcomes of restored perfusion, edema reduction and either demarcation or recovery would be sufficient to guide discontinuing further treatments. For ATI, crush injuries and suturing of severed limbs, HBOT is a valuable adjunctive treatment in combination with accepted standard therapeutic measures when loss of function, limb or life is threatened. Arterial insufficiency ulcers may be treated by HBOT if they persist after reconstructive surgery has restored large vessel function.
Cyanide poisoning Cyanide poisoning carries a high risk of mortality. Victims of smoke inhalation frequently suffer from both carbon monoxide and cyanide poisoning.
The traditional antidote for cyanide poisoning is the infusion of sodium nitrite. This treatment can potentially impair the oxygen carrying capacity of hemoglobin. Using HBOT as an adjunct therapy adds the benefit of increased plasma dissolved oxygen; however, its benefit for pulmonary injury related to smoke inhalation remains experimental.
Treatment typically consists of oxygen administration at 2.5–3.0 ATA for up to 120 minutes during the initial session. Most patients with combination cyanide and carbon monoxide poisoning require only one treatment.
Decompression illness Gas bubbles in tissue or blood, in volumes sufficient enough to interfere with organ function or to cause alteration in sensation resulting from rapid decompression during ascent, presents clinical manifestations ranging from skin eruptions to shock and death.

Page 5 of 39 HBOT with mixed gases is the treatment of choice. The result is immediate reduction in bubble-volume. The treatment prescription is highly variable and case-specific with depths that could range from between 60–165 feet of sea water for durations of 1.5 to > 14 hours. The member may or may not require repeat dives.
Diabetic wounds of the lower extremities All 3 must be met:

Member has type I or type II diabetes with a lower extremity wound secondary to diabetes.
Wound classified as ≥ 3 on the Wagner Scale.
Failure of adequate course of standard wound therapy, as defined by all of the following:
a. Assessment of vascular status and correction of any vascular problems in the affected limb if possible b. Optimization of nutritional status c. Optimization of glucose control d. Debridement by any means to remove devitalized tissue
e. Maintenance of clean, moist bed of granulation tissue with appropriate moist dressings
f. Appropriate off-loading1 g. Necessary treatment to resolve any infection that might be present
HBOT is indicated as an adjunctive therapy only when standard wound treatment has failed (failure is defined as no measurable signs of healing for at least 30 consecutive days). Failure of transcutaneous oxygen measurements to demonstrate adequate local blood flow with which to effect improvement (within any 30-day treatment period) will result in continued treatments to be considered not medically necessary. Emergent anemia One or more of the following:
Active hemolysis with rapidly progressive anemia
Active massive hemorrhage
Severe signs or symptoms unresponsive to volume replacement (eg, Tachycardia, Hypotension, chest pain, cognitive impairment)
Patient unable or unwilling to receive red blood cell transfusions Gas embolism Gas embolism occurs when gases enter the venous or arterial vasculature embolizing in a large enough volume to compromise organ or body-part function and results in ischemia to the affected areas. Air emboli may occur as a result of surgical procedures (e.g., cardiovascular surgery, intra-aortic balloons, arthroplasties, or endoscopies), use of monitoring devices (e.g., Swan-Ganz introducer, infusion pumps), in nonsurgical patients (e.g., diving, ruptured lung in respirator-dependent patient, injection of fluids into tissue space) or traumatic injuries (e.g., gunshot wounds, penetrating chest injuries).
1 For individuals with neuropathic diabetic foot ulcers, total contact casting (or devices where patient removal is detectable) has been shown to heal a higher proportion of wounds in a shorter amount of time than either patient removable cast walkers or half shoes. In practice, patients with patient removable devices were off-loaded for only 22% of steps taken. Failure to adequately off- load the foot exposes the wound to repetitive stress during activity. If, after evaluation at a tertiary care wound center, the patient is not considered a candidate for non-removable devices, then HBOT could be approved.

Page 6 of 39 HBOT, the treatment of choice, is most effective when initiated early and is directed toward reducing the gas- bubble volume and increasing the diffusion gradient of the embolized gas. Treatment modalities range from high pressure to low pressure mixed gas dives.
Gas gangrene HBOT typically consists of oxygen administration at 3.0 ATM for 90 minutes, three times in the first 24 hours. The frequency is decreased to twice daily over the next 4–5 days. Intracranial Abscess One or more of the following:

Supporting evidence, suggestions, and alternatives
Deep or dominant location
Immunocompromised host
Multiple abscesses
Surgery is contraindicated, or patient is poor surgical candidate.
No clinical response or continued deterioration after surgical intervention (1 to 2 needle aspirates) and antibiotic therapy Osteoradionecrosis and soft tissue radionecrosis HBOT for osteoradionecrosis and soft tissue radionecrosis is one part of an overall plan of care that also includes debridement or resection of nonviable tissue in conjunction with antibiotic therapy. Soft tissue flap reconstruction and bone grafting may also be indicated.
HBOT can be indicated in the preoperative and postoperative management of existing osteoradionecrosis or soft tissue radionecrosis and may be utilized prophylactically for dental procedures or as an adjunct to conventional therapy.
Patients who suffer from soft tissue damage or bone necrosis present with disabling, progressive, painful tissue breakdown (i.e., wound dehiscence, infection, tissue loss and graft or flap loss). The HBOT goal is to increase oxygen tension in both hypoxic bone and tissue in order to stimulate growth in functioning capillaries, fibroblastic proliferation and collagen synthesis.
Recommended daily treatment consists of 90–120 minutes at 2.0–2.5 ATA with treatment duration highly individualized and variable per case.
Progressive necrotizing infections (necrotizing fasciitis) Principal treatment consists of surgical debridement and systemic antibiotics. HBOT is recommended as an adjunct only in those settings where mortality and morbidity are expected to be high despite aggressive standard treatment.
Progressive necrotizing fasciitis is a relatively rare infection that is usually a result of a group A streptococcal infection beginning with severe or extensive cellulitis that spreads to involve the superficial and deep fascia, producing thrombosis of the subcutaneous vessels and gangrene of the underlying tissues. A cutaneous lesion often serves as a portal of entry for the infection, but occasionally no such lesion is found.
The histologic hallmark is extensive inflammation and necrosis of the subcutaneous fat, fascia and muscle. Numerous polymorphonuclear leukocytes and mononuclear cells are present in the upper layers of the dermis.

Page 7 of 39 HBOT may be a beneficial adjunct for a subset of patients with anaerobic gram negative necrotizing fasciitis. The recommended protocol is 90 minutes at 2.5 ATA every 8 hrs for the first day and then twice daily for a total or maximum of 10 treatments.
Preparation and preservation of compromised skin grafts Note: HBOT does not apply to the initial preparation of a body site for a graft, nor is it considered medically necessary for normal, uncompromised skin grafts or flaps.
HBOT may be utilized for graft or flap salvage in cases where hypoxia or decreased perfusion has compromised viability. This indication is not for primary management of wounds. HBOT enhances flap survival.
Treatments are administered at a pressure of 2.0–2.5 ATA from 90–120 minutes; twice-daily is not atypical and is reduced to daily when the graft or flap appears stable. Should a graft or flap fail, HBOT may be used to prepare the already compromised recipient site for a new graft or flap.

Documentation HBOT should not be a replacement for successful standard therapeutic measures. Treatment may range from < 1 week to several months in duration. The average treatment time frame is 2–4 weeks; however, duration is dependent upon the member’s severity of illness and HBOT response. Documentation must clearly indicate the reason(s) why HBOT should continue for > 40 treatment sessions.
Documentation in the medical record should support medical necessity and must be submitted (inclusive of photos) upon request. The following information must be documented, as applicable, to the specific medical condition:

Initial assessment and medical history detailing the condition requiring HBOT and a physical exam. The history should list prior treatments including antibiotic therapy and surgical interventions.
Current adjunctive treatment that includes treatment-type and its effectiveness.
Physician progress notes and any communication between physicians detailing past or proposed treatments.
Established HBOT goals.
HBOT session records describing physical findings and treatment rendered (including ascent, descent and total compression times, oxygen dose, pressurization level, documentation of attendance and a recording of events).
Effect of treatment upon established HBOT goals.
Condition-specific information such as the following, as applicable:
a. Laboratory tests (positive Gram-stain smear or culture) to confirm gas gangrene diagnosis.
b. Radiographic tests to confirm gas gangrene clinical diagnosis. c. Threatened loss of function, limb or life. d. Surgical and pathology reports for treatment of necrotizing fasciitis. e. Definitive radiographic findings or positive bone culture with sensitivity studies to confirm osteomyelitis diagnosis and failed antibiotic therapy and surgical management.
f. History of radiation therapy (including date and anatomical site) with documentation of fracture or resorption of bone and radiographic studies, if available, to confirm osteoradionecrosis diagnosis.

Page 8 of 39 g. History of radiation therapy and clinical photographs of necrotic site in support of HBOT medical necessity for soft tissue radionecrosis.
h. Presence of type I or type II diabetes with a lower extremity wound secondary to diabetes that is classified as ≥ 3 on the Wagner scale and which has failed to respond to an adequate course of standard therapy.
i. For treatment of diabetic wounds of the lower extremities, documentation must also reflect that there have been no measurable signs of healing for at least 30 consecutive days of treatment with standard wound therapy and that HBOT is used in addition to standard wound care with wound evaluation at least every 30 days during HBOT.
Table 1 – Wagner’s Classification GRADE 0 At-risk foot, preulcerative lesion (callus), healed ulcers, presence of bony deformity or cellulitis. GRADE 1 Superficial ulcer without subcutaneous tissue involvement. GRADE 2 Penetration through subcutaneous tissue: may expose bone, tendon, ligament, joint capsule or deep fascia without abscess or osteomyelitis.
GRADE 3 Deep ulcer with abscess, osteomyelitis or joint sepsis. GRADE 4 Gangrene localized to a portion of the forefoot or heel. GRADE 5 Gangrene of the whole foot. Limitations and Exclusions

Topical oxygen application is not considered medically necessary, as its efficacy has not been established in the medical literature and it does not fall within the HBOT definition as put forth in the Definition section of this guideline. (See Topical Oxygen Wound Therapy for Medicaid/FHP members)
HBOT is contraindicated during pregnancy, except in cases of carbon monoxide poisoning where it is specifically indicated.
HBOT is not considered medically necessary for any of the following conditions:
 Acute cerebral edema  Acute or chronic cerebral vascular insufficiency  Acute thermal and chemical pulmonary damage, i.e., smoke inhalation with pulmonary insufficiency  Aerobic septicemia  Alzheimer’s disease  Anaerobic septicemia and infection other than clostridial  Arthritic diseases  Autism disorder  Cardiogenic shock  Chronic peripheral vascular insufficiency  Cutaneous, decubitus and stasis ulcers  Hepatic necrosis
 Korsakoff’s disease  Multiple sclerosis  Myocardial infarction

Page 9 of 39  Nonvascular causes of chronic brain syndrome  Organ storage  Organ transplantation
 Pick’s disease  Pulmonary emphysema
 Senility  Sickle cell anemia
 Systemic aerobic infection  Tetanus
 Post-concussive syndrome Procedure Codes 99183 Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session G0277 Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval
ICD-10 Diagnoses A42.0 Pulmonary actinomycosis A42.1 Abdominal actinomycosis A42.2 Cervicofacial actinomycosis A42.81 Actinomycotic meningitis A42.82 Actinomycotic encephalitis A42.89 Other forms of actinomycosis A42.9 Actinomycosis, unspecified A43.0 Pulmonary nocardiosis A43.1 Cutaneous nocardiosis A43.8 Other forms of nocardiosis A43.9 Nocardiosis, unspecified A48.0 Gas gangrene B47.1 Actinomycetoma B47.9 Mycetoma, unspecified D50.0 Iron deficiency anemia secondary to blood loss (chronic) D62 Acute posthemorrhagic anemia E08.51 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene E08.52 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene E08.59 Diabetes mellitus due to underlying condition with other circulatory complications E08.621 Diabetes mellitus due to underlying condition with foot ulcer

Page 10 of 39 E08.622 Diabetes mellitus due to underlying condition with other skin ulcer E08.628 Diabetes mellitus due to underlying condition with other skin complications E09.51 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene E09.52 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene E09.59 Drug or chemical induced diabetes mellitus with other circulatory complications E09.621 Drug or chemical induced diabetes mellitus with foot ulcer E09.622 Drug or chemical induced diabetes mellitus with other skin ulcer E09.628 Drug or chemical induced diabetes mellitus with other skin complications E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene E10.52 Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene E10.59 Type 1 diabetes mellitus with other circulatory complications E10.618 Type 1 diabetes mellitus with other diabetic arthropathy
E10.620 Type 1 diabetes mellitus with diabetic dermatitis
E10.621 Type 1 diabetes mellitus with foot ulcer E10.622 Type 1 diabetes mellitus with other skin ulcer E10.628 Type 1 diabetes mellitus with other skin complications
E10.65 E10.65 Type 1 diabetes mellitus with hyperglycemia
E10.69 E10.69 Type 1 diabetes mellitus with other specified complication
E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene E11.59 Type 2 diabetes mellitus with other circulatory complications E11.618 Type 2 diabetes mellitus with other diabetic arthropathy
E11.620 Type 2 diabetes mellitus with diabetic dermatitis
E11.621 Type 2 diabetes mellitus with foot ulcer E11.622 Type 2 diabetes mellitus with other skin ulcer E11.628 Type 2 diabetes mellitus with other skin complications
E11.65 E11.65 Type 2 diabetes mellitus with hyperglycemia
E11.69 E11.69 Type 2 diabetes mellitus with other specified complication
E13.51 Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene E13.52 Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene E13.59 Other specified diabetes mellitus with other circulatory complications E13.618 Other specified diabetes mellitus with other diabetic arthropathy
E13.620 Other specified diabetes mellitus with diabetic dermatitis -
E13.621 Other specified diabetes mellitus with foot ulcer E13.622 Other specified diabetes mellitus with other skin ulcer E13.628 Other specified diabetes mellitus with other skin complications

Page 11 of 39 G06.0 Intracranial abscess and granuloma G06.1 Intraspinal abscess and granuloma G06.2 Extradural and subdural abscess, unspecified H34.10
Central retinal artery occlusion, unspecified eye H34.11
Central retinal artery occlusion, right eye H34.12
Central retinal artery occlusion, left eye H34.13
Central retinal artery occlusion, bilatera H91.20 Sudden idiopathic hearing loss, unspecified ear H91.21 Sudden idiopathic hearing loss, right ear H91.22 Sudden idiopathic hearing loss, left ear H91.23 Sudden idiopathic hearing loss, bilateral I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower right leg (Revised 10/01/2019) I70.239 Atherosclerosis of native arteries of right leg with ulceration of unspecified site I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower left leg (Revised 10/01/2019) I70.249 Atherosclerosis of native arteries of left leg with ulceration of unspecified site I70.25 Atherosclerosis of native arteries of other extremities with ulceration I70.331 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of thigh I70.333 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of ankle I70.334 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot I70.335 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of foot I70.338 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of lower leg I70.339 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of unspecified site I70.341 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of thigh I70.343 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of ankle I70.344 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of heel and midfoot

Page 12 of 39 I70.345 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of other part of foot I70.348 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of other part of lower leg I70.349 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of unspecified site I70.431 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot I70.435 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot I70.438 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of lower leg I70.439 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of unspecified site I70.441 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot I70.445 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot I70.448 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of lower leg I70.449 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of unspecified site I70.531 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot I70.538 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of lower leg I70.539 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of unspecified site I70.541 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot I70.545 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot I70.548 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of lower leg I70.549 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of unspecified site I70.631 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh I70.633 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle I70.634 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot I70.635 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of foot I70.638 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of lower leg I70.639 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of unspecified site I70.641 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh

Page 13 of 39 I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle I70.644 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot I70.645 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of foot I70.648 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of lower leg I70.649 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of unspecified site I70.731 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of thigh I70.733 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of ankle I70.734 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot I70.735 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of foot I70.738 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of lower leg I70.739 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of unspecified site I70.741 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh I70.743 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of ankle I70.744 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot I70.745 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot I70.748 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of lower leg I70.749 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of unspecified site I74.2 Embolism and thrombosis of arteries of the upper extremities I74.3 Embolism and thrombosis of arteries of the lower extremities I74.5 Embolism and thrombosis of iliac artery L08.1 Erythrasma L59.8 Other specified disorders of the skin and subcutaneous tissue related to radiation L97.115 Non-pressure chronic ulcer of right thigh with muscle involvement without evidence of necrosis
L97.116 Non-pressure chronic ulcer of right thigh with bone involvement without evidence of necrosis
L97.118 Non-pressure chronic ulcer of right thigh with other specified severity
L97.125 Non-pressure chronic ulcer of left thigh with muscle involvement without evidence of necrosis
L97.126 Non-pressure chronic ulcer of left thigh with bone involvement without evidence of necrosis
L97.128 Non-pressure chronic ulcer of left thigh with other specified severity
L97.215 Non-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis
L97.216 Non-pressure chronic ulcer of right calf with bone involvement without evidence of necrosis
L97.218 Non-pressure chronic ulcer of right calf with other specified severity
L97.225 Non-pressure chronic ulcer of left calf with muscle involvement without evidence of necrosis
L97.226 Non-pressure chronic ulcer of left calf with bone involvement without evidence of necrosis
L97.228 Non-pressure chronic ulcer of left calf with other specified severity
L97.315 Non-pressure chronic ulcer of right ankle with muscle involvement without evidence of necrosis
L97.316 Non-pressure chronic ulcer of right ankle with bone involvement without evidence of necrosis

Page 14 of 39 L97.318 Non-pressure chronic ulcer of right ankle with other specified severity
L97.325 Non-pressure chronic ulcer of left ankle with muscle involvement without evidence of necrosis
L97.326 Non-pressure chronic ulcer of left ankle with bone involvement without evidence of necrosis
L97.328 Non-pressure chronic ulcer of left ankle with other specified severity
L97.415 Non-pressure chronic ulcer of right heel and midfoot with muscle involvement without evidence of necrosis
L97.416 Non-pressure chronic ulcer of right heel and midfoot with bone involvement without evidence of necrosis
L97.418 Non-pressure chronic ulcer of right heel and midfoot with other specified severity
L97.425 Non-pressure chronic ulcer of left heel and midfoot with muscle involvement without evidence of necrosis
L97.426 Non-pressure chronic ulcer of left heel and midfoot with bone involvement without evidence of necrosis
L97.428 Non-pressure chronic ulcer of left heel and midfoot with other specified severity
L97.515 Non-pressure chronic ulcer of other part of right foot with muscle involvement without evidence of necrosis
L97.516 Non-pressure chronic ulcer of other part of right foot with bone involvement without evidence of necrosis
L97.518 Non-pressure chronic ulcer of other part of right foot with other specified severity
L97.525 Non-pressure chronic ulcer of other part of left foot with muscle involvement without evidence of necrosis
L97.526 Non-pressure chronic ulcer of other part of left foot with bone involvement without evidence of necrosis
L97.528 Non-pressure chronic ulcer of other part of left foot with other specified severity
L97.815 Non-pressure chronic ulcer of other part of right lower leg with muscle involvement without evidence of necrosis
L97.816 Non-pressure chronic ulcer of other part of right lower leg with bone involvement without evidence of necrosis
L97.818 Non-pressure chronic ulcer of other part of right lower leg with other specified severity
L97.825 Non-pressure chronic ulcer of other part of left lower leg with muscle involvement without evidence of necrosis
L97.826 Non-pressure chronic ulcer of other part of left lower leg with bone involvement without evidence of necrosis
L97.828 Non-pressure chronic ulcer of other part of left lower leg with other specified severity M27.2 Inflammatory conditions of jaws M27.8 Other specified diseases of jaws M72.6 Necrotizing fasciitis M86.30 Chronic multifocal osteomyelitis, unspecified site M86.311 Chronic multifocal osteomyelitis, right shoulder M86.312 Chronic multifocal osteomyelitis, left shoulder M86.319 Chronic multifocal osteomyelitis, unspecified shoulder M86.321 Chronic multifocal osteomyelitis, right humerus M86.322 Chronic multifocal osteomyelitis, left humerus M86.329 Chronic multifocal osteomyelitis, unspecified humerus M86.331 Chronic multifocal osteomyelitis, right radius and ulna M86.332 Chronic multifocal osteomyelitis, left radius and ulna M86.339 Chronic multifocal osteomyelitis, unspecified radius and ulna

Page 15 of 39 M86.341 Chronic multifocal osteomyelitis, right hand M86.342 Chronic multifocal osteomyelitis, left hand M86.349 Chronic multifocal osteomyelitis, unspecified hand M86.351 Chronic multifocal osteomyelitis, right femur M86.352 Chronic multifocal osteomyelitis, left femur M86.359 Chronic multifocal osteomyelitis, unspecified femur M86.361 Chronic multifocal osteomyelitis, right tibia and fibula M86.362 Chronic multifocal osteomyelitis, left tibia and fibula M86.369 Chronic multifocal osteomyelitis, unspecified tibia and fibula M86.371 Chronic multifocal osteomyelitis, right ankle and foot M86.372 Chronic multifocal osteomyelitis, left ankle and foot M86.379 Chronic multifocal osteomyelitis, unspecified ankle and foot M86.38 Chronic multifocal osteomyelitis, other site M86.39 Chronic multifocal osteomyelitis, multiple sites M86.40 Chronic osteomyelitis with draining sinus, unspecified site M86.411 Chronic osteomyelitis with draining sinus, right shoulder M86.412 Chronic osteomyelitis with draining sinus, left shoulder M86.419 Chronic osteomyelitis with draining sinus, unspecified shoulder M86.421 Chronic osteomyelitis with draining sinus, right humerus M86.422 Chronic osteomyelitis with draining sinus, left humerus M86.429 Chronic osteomyelitis with draining sinus, unspecified humerus M86.431 Chronic osteomyelitis with draining sinus, right radius and ulna M86.432 Chronic osteomyelitis with draining sinus, left radius and ulna M86.439 Chronic osteomyelitis with draining sinus, unspecified radius and ulna M86.441 Chronic osteomyelitis with draining sinus, right hand M86.442 Chronic osteomyelitis with draining sinus, left hand M86.449 Chronic osteomyelitis with draining sinus, unspecified hand M86.451 Chronic osteomyelitis with draining sinus, right femur M86.452 Chronic osteomyelitis with draining sinus, left femur M86.459 Chronic osteomyelitis with draining sinus, unspecified femur M86.461 Chronic osteomyelitis with draining sinus, right tibia and fibula M86.462 Chronic osteomyelitis with draining sinus, left tibia and fibula M86.469 Chronic osteomyelitis with draining sinus, unspecified tibia and fibula M86.471 Chronic osteomyelitis with draining sinus, right ankle and foot M86.472 Chronic osteomyelitis with draining sinus, left ankle and foot M86.479 Chronic osteomyelitis with draining sinus, unspecified ankle and foot

Page 16 of 39 M86.48 Chronic osteomyelitis with draining sinus, other site M86.49 Chronic osteomyelitis with draining sinus, multiple sites M86.50 Other chronic hematogenous osteomyelitis, unspecified site M86.511 Other chronic hematogenous osteomyelitis, right shoulder M86.512 Other chronic hematogenous osteomyelitis, left shoulder M86.519 Other chronic hematogenous osteomyelitis, unspecified shoulder M86.521 Other chronic hematogenous osteomyelitis, right humerus M86.522 Other chronic hematogenous osteomyelitis, left humerus M86.529 Other chronic hematogenous osteomyelitis, unspecified humerus M86.531 Other chronic hematogenous osteomyelitis, right radius and ulna M86.532 Other chronic hematogenous osteomyelitis, left radius and ulna M86.539 Other chronic hematogenous osteomyelitis, unspecified radius and ulna M86.541 Other chronic hematogenous osteomyelitis, right hand M86.542 Other chronic hematogenous osteomyelitis, left hand M86.549 Other chronic hematogenous osteomyelitis, unspecified hand M86.551 Other chronic hematogenous osteomyelitis, right femur M86.552 Other chronic hematogenous osteomyelitis, left femur M86.559 Other chronic hematogenous osteomyelitis, unspecified femur M86.561 Other chronic hematogenous osteomyelitis, right tibia and fibula M86.562 Other chronic hematogenous osteomyelitis, left tibia and fibula M86.569 Other chronic hematogenous osteomyelitis, unspecified tibia and fibula M86.571 Other chronic hematogenous osteomyelitis, right ankle and foot M86.572 Other chronic hematogenous osteomyelitis, left ankle and foot M86.579 Other chronic hematogenous osteomyelitis, unspecified ankle and foot M86.58 Other chronic hematogenous osteomyelitis, other site M86.59 Other chronic hematogenous osteomyelitis, multiple sites M86.60 Other chronic osteomyelitis, unspecified site M86.611 Other chronic osteomyelitis, right shoulder M86.612 Other chronic osteomyelitis, left shoulder M86.619 Other chronic osteomyelitis, unspecified shoulder M86.621 Other chronic osteomyelitis, right humerus M86.622 Other chronic osteomyelitis, left humerus M86.629 Other chronic osteomyelitis, unspecified humerus M86.631 Other chronic osteomyelitis, right radius and ulna M86.632 Other chronic osteomyelitis, left radius and ulna M86.639 Other chronic osteomyelitis, unspecified radius and ulna

Page 17 of 39 M86.641 Other chronic osteomyelitis, right hand M86.642 Other chronic osteomyelitis, left hand M86.649 Other chronic osteomyelitis, unspecified hand M86.651 Other chronic osteomyelitis, right thigh M86.652 Other chronic osteomyelitis, left thigh M86.659 Other chronic osteomyelitis, unspecified thigh M86.661 Other chronic osteomyelitis, right tibia and fibula M86.662 Other chronic osteomyelitis, left tibia and fibula M86.669 Other chronic osteomyelitis, unspecified tibia and fibula M86.671 Other chronic osteomyelitis, right ankle and foot M86.672 Other chronic osteomyelitis, left ankle and foot M86.679 Other chronic osteomyelitis, unspecified ankle and foot M86.68 Other chronic osteomyelitis, other site M86.69 Other chronic osteomyelitis, multiple sites M86.8X0 Other osteomyelitis, multiple sites M86.8X1 Other osteomyelitis, shoulder M86.8X2 Other osteomyelitis, upper arm M86.8X3 Other osteomyelitis, forearm M86.8X4 Other osteomyelitis, hand M86.8X5 Other osteomyelitis, thigh M86.8X6 Other osteomyelitis, lower leg M86.8X7 Other osteomyelitis, ankle and foot M86.8X8 Other osteomyelitis, other site M86.8X9 Other osteomyelitis, unspecified sites M87.00
Idiopathic aseptic necrosis of unspecified bone M87.011
Idiopathic aseptic necrosis of right shoulder M87.012
Idiopathic aseptic necrosis of left shoulder M87.019
Idiopathic aseptic necrosis of unspecified shoulder M87.021
Idiopathic aseptic necrosis of right humerus M87.022
Idiopathic aseptic necrosis of left humerus M87.029
Idiopathic aseptic necrosis of unspecified humerus M87.031
Idiopathic aseptic necrosis of right radius M87.032
Idiopathic aseptic necrosis of left radius M87.033
Idiopathic aseptic necrosis of unspecified radius M87.034
Idiopathic aseptic necrosis of right ulna M87.035
Idiopathic aseptic necrosis of left ulna

Page 18 of 39 M87.036
Idiopathic aseptic necrosis of unspecified ulna M87.037
Idiopathic aseptic necrosis of right carpus M87.038
Idiopathic aseptic necrosis of left carpus M87.039
Idiopathic aseptic necrosis of unspecified carpus M87.041
Idiopathic aseptic necrosis of right hand M87.042
Idiopathic aseptic necrosis of left hand M87.043
Idiopathic aseptic necrosis of unspecified hand M87.044
Idiopathic aseptic necrosis of right finger(s) M87.045
Idiopathic aseptic necrosis of left finger(s) M87.046
Idiopathic aseptic necrosis of unspecified finger(s) M87.050
Idiopathic aseptic necrosis of pelvis M87.051
Idiopathic aseptic necrosis of right femur M87.052
Idiopathic aseptic necrosis of left femur M87.059
Idiopathic aseptic necrosis of unspecified femur M87.061
Idiopathic aseptic necrosis of right tibia M87.062
Idiopathic aseptic necrosis of left tibia M87.063
Idiopathic aseptic necrosis of unspecified tibia M87.064
Idiopathic aseptic necrosis of right fibula M87.065
Idiopathic aseptic necrosis of left fibula M87.066
Idiopathic aseptic necrosis of unspecified fibula M87.071
Idiopathic aseptic necrosis of right ankle M87.072 Idiopathic aseptic necrosis of left ankle M87.073
Idiopathic aseptic necrosis of unspecified ankle M87.074
Idiopathic aseptic necrosis of right foot M87.075
Idiopathic aseptic necrosis of left foot M87.076
Idiopathic aseptic necrosis of unspecified foot M87.077
Idiopathic aseptic necrosis of right toe(s) M87.078
Idiopathic aseptic necrosis of left toe(s) M87.079
Idiopathic aseptic necrosis of unspecified toe(s) M87.08
Idiopathic aseptic necrosis of bone, other site M87.09
Idiopathic aseptic necrosis of bone, multiple sites M87.9
Osteonecrosis, unspecified N30.40 Irradiation cystitis without hematuria N30.41 Irradiation cystitis with hematuria S35.511A Injury of right iliac artery, initial encounter S35.512A Injury of left iliac artery, initial encounter

Page 19 of 39 S45.011A Laceration of axillary artery, right side, initial encounter S45.012A Laceration of axillary artery, left side, initial encounter S45.091A Other specified injury of axillary artery, right side, initial encounter S45.092A Other specified injury of axillary artery, left side, initial encounter S45.111A Laceration of brachial artery, right side, initial encounter S45.112A Laceration of brachial artery, left side, initial encounter S45.191A Other specified injury of brachial artery, right side, initial encounter S45.192A Other specified injury of brachial artery, left side, initial encounter S45.211A Laceration of axillary or brachial vein, right side, initial encounter S45.212A Laceration of axillary or brachial vein, left side, initial encounter S45.291A Other specified injury of axillary or brachial vein, right side, initial encounter S45.292A Other specified injury of axillary or brachial vein, left side, initial encounter S47.1xxA Crushing injury of right shoulder and upper arm, initial encounter S47.2xxA Crushing injury of left shoulder and upper arm, initial encounter S47.9xxA Crushing injury of shoulder and upper arm, unspecified arm, initial encounter S57.00xA Crushing injury of unspecified elbow, initial encounter S57.01xA Crushing injury of right elbow, initial encounter S57.02xA Crushing injury of left elbow, initial encounter S57.80xA Crushing injury of unspecified forearm, initial encounter S57.81xA Crushing injury of right forearm, initial encounter S57.82xA Crushing injury of left forearm, initial encounter S67.01XA Crushing injury of right thumb, initial encounter S67.02XA Crushing injury of left thumb, initial encounter S67.190A Crushing injury of right index finger, initial encounter S67.191A Crushing injury of left index finger, initial encounter S67.192A Crushing injury of right middle finger, initial encounter S67.193A Crushing injury of left middle finger, initial encounter S67.194A Crushing injury of right ring finger, initial encounter S67.195A Crushing injury of left ring finger, initial encounter S67.196A Crushing injury of right little finger, initial encounter S67.197A Crushing injury of left little finger, initial encounter S67.20xA Crushing injury of unspecified hand, initial encounter S67.21xA Crushing injury of right hand, initial encounter S67.22xA Crushing injury of left hand, initial encounter S67.30xA Crushing injury of unspecified wrist, initial encounter S67.31xA Crushing injury of right wrist, initial encounter

Page 20 of 39 S67.32xA Crushing injury of left wrist, initial encounter S67.40xA Crushing injury of unspecified wrist and hand, initial encounter S67.41xA Crushing injury of right wrist and hand, initial encounter S67.42xA Crushing injury of left wrist and hand, initial encounter S67.90xA Crushing injury of unspecified part(s) of unspecified wrist, hand and fingers, initial encounter S67.91xA Crushing injury of unspecified part(s) of right wrist, hand and fingers, initial encounter S67.92xA Crushing injury of unspecified part(s) of left wrist, hand and fingers, initial encounter S75.011A Minor laceration of femoral artery, right leg, initial encounter S75.012A Minor laceration of femoral artery, left leg, initial encounter S75.021A Major laceration of femoral artery, right leg, initial encounter S75.022A Major laceration of femoral artery, left leg, initial encounter S75.091A Other specified injury of femoral artery, right leg, initial encounter S75.092A Other specified injury of femoral artery, left leg, initial encounter S77.00xA Crushing injury of unspecified hip, initial encounter S77.01xA Crushing injury of right hip, initial encounter S77.02xA Crushing injury of left hip, initial encounter S77.10xA Crushing injury of unspecified thigh, initial encounter S77.11xA Crushing injury of right thigh, initial encounter S77.12xA Crushing injury of left thigh, initial encounter S77.20xA Crushing injury of unspecified hip with thigh, initial encounter S77.21xA Crushing injury of right hip with thigh, initial encounter S77.22xA Crushing injury of left hip with thigh, initial encounter S85.011A Laceration of popliteal artery, right leg, initial encounter S85.012A Laceration of popliteal artery, left leg, initial encounter S85.091A Other specified injury of popliteal artery, right leg, initial encounter S85.092A Other specified injury of popliteal artery, left leg, initial encounter S87.00xA Crushing injury of unspecified knee, initial encounter S87.01xA Crushing injury of right knee, initial encounter S87.02xA Crushing injury of left knee, initial encounter S87.80xA Crushing injury of unspecified lower leg, initial encounter S87.81xA Crushing injury of right lower leg, initial encounter S87.82xA Crushing injury of left lower leg, initial encounter S97.00xA Crushing injury of unspecified ankle, initial encounter S97.01xA Crushing injury of right ankle, initial encounter S97.02xA Crushing injury of left ankle, initial encounter S97.101A Crushing injury of unspecified right toe(s), initial encounter

Page 21 of 39 S97.102A Crushing injury of unspecified left toe(s), initial encounter S97.109A Crushing injury of unspecified toe(s), initial encounter S97.111A Crushing injury of right great toe, initial encounter S97.112A Crushing injury of left great toe, initial encounter S97.119A Crushing injury of unspecified great toe, initial encounter S97.121A Crushing injury of right lesser toe(s), initial encounter S97.122A Crushing injury of left lesser toe(s), initial encounter S97.129A Crushing injury of unspecified lesser toe(s), initial encounter S97.80xA Crushing injury of unspecified foot, initial encounter S97.81xA Crushing injury of right foot, initial encounter S97.82xA Crushing injury of left foot, initial encounter T20.20XA
Burn of second degree of head, face, and neck, unspecified site, initial encounter T20.20XD
Burn of second degree of head, face, and neck, unspecified site, subsequent encounter T20.20XS
Burn of second degree of head, face, and neck, unspecified site, sequela T20.20XS
Burn of second degree of head, face, and neck, unspecified site, sequela T20.211A
Burn of second degree of right ear [any part, except ear drum], initial encounter T20.211D
Burn of second degree of right ear [any part, except ear drum], subsequent encounter T20.211S
Burn of second degree of right ear [any part, except ear drum], sequela T20.212A
Burn of second degree of left ear [any part, except ear drum], initial encounter T20.212D
Burn of second degree of left ear [any part, except ear drum], subsequent encounter T20.212S
Burn of second degree of left ear [any part, except ear drum], sequela T20.219A
Burn of second degree of unspecified ear [any part, except ear drum], initial encounter T20.219D
Burn of second degree of unspecified ear [any part, except ear drum], subsequent encounter T20.219S
Burn of second degree of unspecified ear [any part, except ear drum], sequela T20.22XA
Burn of second degree of lip(s), initial encounter T20.22XD
Burn of second degree of lip(s), subsequent encounter T20.22XS
Burn of second degree of lip(s), sequela T20.23XA
Burn of second degree of chin, initial encounter T20.23XD
Burn of second degree of chin, subsequent encounter T20.23XS
Burn of second degree of chin, sequela T20.24XA
Burn of second degree of nose (septum), initial encounter T20.24XD
Burn of second degree of nose (septum), subsequent encounter T20.24XS
Burn of second degree of nose (septum), sequela T20.25XA
Burn of second degree of scalp [any part], initial encounter T20.25XD
Burn of second degree of scalp [any part], subsequent encounter T20.25XS
Burn of second degree of scalp [any part], sequela

Page 22 of 39 T20.26XA
Burn of second degree of forehead and cheek, initial encounter T20.26XD
Burn of second degree of forehead and cheek, subsequent encounter T20.26XS
Burn of second degree of forehead and cheek, sequela T20.27XA
Burn of second degree of neck, initial encounter T20.27XD
Burn of second degree of neck, subsequent encounter T20.27XS
Burn of second degree of neck, sequela T20.29XA
Burn of second degree of multiple sites of head, face, and neck, initial encounter T20.29XD
Burn of second degree of multiple sites of head, face, and neck, subsequent encounter T20.29XS
Burn of second degree of multiple sites of head, face, and neck, sequela T20.30XA
Burn of third degree of head, face, and neck, unspecified site, initial encounter T20.30XD
Burn of third degree of head, face, and neck, unspecified site, subsequent encounter T20.30XS
Burn of third degree of head, face, and neck, unspecified site, sequela T20.311A
Burn of third degree of right ear [any part, except ear drum], initial encounter T20.311D
Burn of third degree of right ear [any part, except ear drum], subsequent encounter T20.311S
Burn of third degree of right ear [any part, except ear drum], sequela T20.312A
Burn of third degree of left ear [any part, except ear drum], initial encounter T20.312D
Burn of third degree of left ear [any part, except ear drum], subsequent encounter T20.312S
Burn of third degree of left ear [any part, except ear drum], sequela T20.319A
Burn of third degree of unspecified ear [any part, except ear drum], initial encounter T20.319D
Burn of third degree of unspecified ear [any part, except ear drum], subsequent encounter T20.319S
Burn of third degree of unspecified ear [any part, except ear drum], sequela T20.32XA
Burn of third degree of lip(s), initial encounter T20.32XD
Burn of third degree of lip(s), subsequent encounter T20.32XS
Burn of third degree of lip(s), sequela T20.33XA
Burn of third degree of chin, initial encounter T20.33XD
Burn of third degree of chin, subsequent encounter T20.33XS
Burn of third degree of chin, sequela T20.34XA
Burn of third degree of nose (septum), initial encounter T20.34XD
Burn of third degree of nose (septum), subsequent encounter T20.34XS
Burn of third degree of nose (septum), sequela T20.35XA
Burn of third degree of scalp [any part], initial encounter T20.35XD
Burn of third degree of scalp [any part], subsequent encounter T20.35XS
Burn of third degree of scalp [any part], sequela T20.36XA
Burn of third degree of forehead and cheek, initial encounter T20.36XD
Burn of third degree of forehead and cheek, subsequent encounter T20.36XS
Burn of third degree of forehead and cheek, sequela

Page 23 of 39 T20.37XA
Burn of third degree of neck, initial encounter T20.37XD
Burn of third degree of neck, subsequent encounter T20.37XS
Burn of third degree of neck, sequela T20.39XA
Burn of third degree of multiple sites of head, face, and neck, initial encounter T20.39XD
Burn of third degree of multiple sites of head, face, and neck, subsequent encounter T20.39XS
Burn of third degree of multiple sites of head, face, and neck, sequela T21.20XA
Burn of second degree of trunk, unspecified site, initial encounter T21.20XD
Burn of second degree of trunk, unspecified site, subsequent encounter T21.20XS
Burn of second degree of trunk, unspecified site, sequela T21.21XA
Burn of second degree of chest wall, initial encounter T21.21XD
Burn of second degree of chest wall, subsequent encounter T21.21XS
Burn of second degree of chest wall, sequela T21.22XA
Burn of second degree of abdominal wall, initial encounter T21.22XD
Burn of second degree of abdominal wall, subsequent encounter T21.22XS
Burn of second degree of abdominal wall, sequela T21.23XA
Burn of second degree of upper back, initial encounter T21.23XD
Burn of second degree of upper back, subsequent encounter T21.23XS
Burn of second degree of upper back, sequela T21.24XA
Burn of second degree of lower back, initial encounter T21.24XD
Burn of second degree of lower back, subsequent encounter T21.24XS
Burn of second degree of lower back, sequela T21.25XA
Burn of second degree of buttock, initial encounter T21.25XD
Burn of second degree of buttock, subsequent encounter T21.25XS
Burn of second degree of buttock, sequela T21.26XA
Burn of second degree of male genital region, initial encounter T21.26XD
Burn of second degree of male genital region, subsequent encounter T21.26XS
Burn of second degree of male genital region, sequela T21.27XA
Burn of second degree of female genital region, initial encounter T21.27XD
Burn of second degree of female genital region, subsequent encounter T21.27XS
Burn of second degree of female genital region, sequela T21.29XA
Burn of second degree of other site of trunk, initial encounter T21.29XD
Burn of second degree of other site of trunk, subsequent encounter T21.29XS
Burn of second degree of other site of trunk, sequela T21.30XA
Burn of third degree of trunk, unspecified site, initial encounter T21.30XD
Burn of third degree of trunk, unspecified site, subsequent encounter T21.30XS
Burn of third degree of trunk, unspecified site, sequela

Page 24 of 39 T21.31XA
Burn of third degree of chest wall, initial encounter T21.31XD
Burn of third degree of chest wall, subsequent encounter T21.31XS
Burn of third degree of chest wall, sequela T21.32XA
Burn of third degree of abdominal wall, initial encounter T21.32XD
Burn of third degree of abdominal wall, subsequent encounter T21.32XS
Burn of third degree of abdominal wall, sequela T21.33XA
Burn of third degree of upper back, initial encounter T21.33XD
Burn of third degree of upper back, subsequent encounter T21.33XS
Burn of third degree of upper back, sequela T21.34XA
Burn of third degree of lower back, initial encounter T21.34XD
Burn of third degree of lower back, subsequent encounter T21.34XS
Burn of third degree of lower back, sequela T21.35XA
Burn of third degree of buttock, initial encounter T21.35XD
Burn of third degree of buttock, subsequent encounter T21.35XS
Burn of third degree of buttock, sequela T21.36XA
Burn of third degree of male genital region, initial encounter T21.36XD
Burn of third degree of male genital region, subsequent encounter T21.36XS
Burn of third degree of male genital region, sequela T21.37XA
Burn of third degree of female genital region, initial encounter T21.37XD
Burn of third degree of female genital region, subsequent encounter T21.37XS
Burn of third degree of female genital region, sequela T21.39XA
Burn of third degree of other site of trunk, initial encounter T21.39XD
Burn of third degree of other site of trunk, subsequent encounter T21.39XS
Burn of third degree of other site of trunk, sequela T22.20XA
Burn of second degree of shoulder and upper limb, except wrist and hand, unspecified site, initial
T22.20XD
Burn of second degree of shoulder and upper limb, except wrist and hand, unspecified site,
T22.20XS
Burn of second degree of shoulder and upper limb, except wrist and hand, unspecified site, sequela T22.211A
Burn of second degree of right forearm, initial encounter T22.211D
Burn of second degree of right forearm, subsequent encounter T22.211S
Burn of second degree of right forearm, sequela T22.212A
Burn of second degree of left forearm, initial encounter T22.212D
Burn of second degree of left forearm, subsequent encounter T22.212S
Burn of second degree of left forearm, sequela T22.219A
Burn of second degree of unspecified forearm, initial encounter T22.219D
Burn of second degree of unspecified forearm, subsequent encounter T22.219S
Burn of second degree of unspecified forearm, sequela

Page 25 of 39 T22.221A
Burn of second degree of right elbow, initial encounter T22.221D
Burn of second degree of right elbow, subsequent encounter T22.221S
Burn of second degree of right elbow, sequela T22.222A
Burn of second degree of left elbow, initial encounter T22.222D
Burn of second degree of left elbow, subsequent encounter T22.222S
Burn of second degree of left elbow, sequela T22.229A
Burn of second degree of unspecified elbow, initial encounte T22.229D
Burn of second degree of unspecified elbow, subsequent encounter T22.229S
Burn of second degree of unspecified elbow, sequela T22.231A
Burn of second degree of right upper arm, initial encounter T22.231D
Burn of second degree of right upper arm, subsequent encounter T22.231S
Burn of second degree of right upper arm, sequela T22.232A
Burn of second degree of left upper arm, initial encounter T22.232D
Burn of second degree of left upper arm, subsequent encounter T22.232S
Burn of second degree of left upper arm, sequela T22.239A
Burn of second degree of unspecified upper arm, initial encounter T22.239D
Burn of second degree of unspecified upper arm, subsequent encounter T22.239S
Burn of second degree of unspecified upper arm, sequela T22.241A
Burn of second degree of right axilla, initial encounter T22.241D
Burn of second degree of right axilla, subsequent encounter T22.241S
Burn of second degree of right axilla, sequela T22.242A
Burn of second degree of left axilla, initial encounter T22.242D
Burn of second degree of left axilla, subsequent encounter T22.242S
Burn of second degree of left axilla, sequela T22.249A
Burn of second degree of unspecified axilla, initial encounter T22.249D
Burn of second degree of unspecified axilla, subsequent encounter T22.249S
Burn of second degree of unspecified axilla, sequela T22.251A
Burn of second degree of right shoulder, initial encounter T22.251D
Burn of second degree of right shoulder, subsequent encounter T22.251S
Burn of second degree of right shoulder, sequela T22.252A
Burn of second degree of left shoulder, initial encounter T22.252D
Burn of second degree of left shoulder, subsequent encounter T22.252S
Burn of second degree of left shoulder, sequela T22.259A
Burn of second degree of unspecified shoulder, initial encounter T22.259D
Burn of second degree of unspecified shoulder, subsequent encounter T22.259S
Burn of second degree of unspecified shoulder, sequela

Page 26 of 39 T22.261A
Burn of second degree of right scapular region, initial encounter T22.261D
Burn of second degree of right scapular region, subsequent encounter T22.261S
Burn of second degree of right scapular region, sequela T22.262A
Burn of second degree of left scapular region, initial encounter T22.262D
Burn of second degree of left scapular region, subsequent encounter T22.262S
Burn of second degree of left scapular region, sequela T22.269A
Burn of second degree of unspecified scapular region, initial encounter T22.269D
Burn of second degree of unspecified scapular region, subsequent encounter T22.269S
Burn of second degree of unspecified scapular region, sequela T22.291A
Burn of second degree of multiple sites of right shoulder and upper limb, except wrist and hand,
T22.291S
Burn of second degree of multiple sites of right shoulder and upper limb, except wrist and hand,
T22.292A
Burn of second degree of multiple sites of left shoulder and upper limb, except wrist and hand, initial
T22.292D
Burn of second degree of multiple sites of left shoulder and upper limb, except wrist and hand,
T22.292S
Burn of second degree of multiple sites of left shoulder and upper limb, except wrist and hand,
T22.299A
Burn of second degree of multiple sites of unspecified shoulder and upper limb, except wrist and
T22.299D
Burn of second degree of multiple sites of unspecified shoulder and upper limb, except wrist and hand, subsequent encounter T22.299S
Burn of second degree of multiple sites of unspecified shoulder and upper limb, except wrist and hand, sequela T22.30XA
Burn of third degree of shoulder and upper limb, except wrist and hand, unspecified site, initial
T22.30XD
Burn of third degree of shoulder and upper limb, except wrist and hand, unspecified site,
T22.30XS
Burn of third degree of shoulder and upper limb, except wrist and hand, unspecified site, sequela T22.311A
Burn of third degree of right forearm, initial encounter T22.311D
Burn of third degree of right forearm, subsequent encounter T22.311S
Burn of third degree of right forearm, sequela T22.312A
Burn of third degree of left forearm, initial encounter T22.312D
Burn of third degree of left forearm, subsequent encounter T22.312S
Burn of third degree of left forearm, sequela T22.319A
Burn of third degree of unspecified forearm, initial encounter T22.319D
Burn of third degree of unspecified forearm, subsequent encounter T22.319S
Burn of third degree of unspecified forearm, sequela T22.321A
Burn of third degree of right elbow, initial encounter T22.321D
Burn of third degree of right elbow, subsequent encounter T22.321S
Burn of third degree of right elbow, sequela T22.322A
Burn of third degree of left elbow, initial encounter T22.322D
Burn of third degree of left elbow, subsequent encounter T22.322S
Burn of third degree of left elbow, sequela

Page 27 of 39 T22.329A
Burn of third degree of unspecified elbow, initial encounter T22.329D
Burn of third degree of unspecified elbow, subsequent encounter T22.329S
Burn of third degree of unspecified elbow, sequela T22.331A
Burn of third degree of right upper arm, initial encounter T22.331D
Burn of third degree of right upper arm, subsequent encounter T22.331S
Burn of third degree of right upper arm, sequela T22.332A
Burn of third degree of left upper arm, initial encounter T22.332D
Burn of third degree of left upper arm, subsequent encounter T22.332S
Burn of third degree of left upper arm, sequela T22.339A
Burn of third degree of unspecified upper arm, initial encounter T22.339D
Burn of third degree of unspecified upper arm, subsequent encounter T22.339S
Burn of third degree of unspecified upper arm, sequela T22.341A
Burn of third degree of right axilla, initial encounter T22.341D Burn of third degree of right axilla, subsequent encounter T22.341S
Burn of third degree of right axilla, sequela T22.342A
Burn of third degree of left axilla, initial encounter T22.342D
Burn of third degree of left axilla, subsequent encounter T22.342S
Burn of third degree of left axilla, sequela T22.349A
Burn of third degree of unspecified axilla, initial encounter T22.349D
Burn of third degree of unspecified axilla, subsequent encounter T22.349S
Burn of third degree of unspecified axilla, sequela T22.351A
Burn of third degree of right shoulder, initial encounter T22.351D
Burn of third degree of right shoulder, subsequent encounter T22.351S
Burn of third degree of right shoulder, sequela T22.352A
Burn of third degree of left shoulder, initial encounter T22.352D
Burn of third degree of left shoulder, subsequent encounter T22.352S
Burn of third degree of left shoulder, sequela T22.359A
Burn of third degree of unspecified shoulder, initial encounter T22.359D
Burn of third degree of unspecified shoulder, subsequent encounter T22.359S
Burn of third degree of unspecified shoulder, sequela T22.361A
Burn of third degree of right scapular region, initial encounter T22.361D
Burn of third degree of right scapular region, subsequent encounter T22.361S
Burn of third degree of right scapular region, sequela T22.362A
Burn of third degree of left scapular region, initial encounter T22.362D
Burn of third degree of left scapular region, subsequent encounter T22.362S
Burn of third degree of left scapular region, sequela

Page 28 of 39 T22.369A
Burn of third degree of unspecified scapular region, initial encounter T22.369D
Burn of third degree of unspecified scapular region, subsequent encounter T22.369S
Burn of third degree of unspecified scapular region, sequela T22.391A
Burn of third degree of multiple sites of right shoulder and upper limb, except wrist and hand, initial
T22.391D
Burn of third degree of multiple sites of right shoulder and upper limb, except wrist and hand,
T22.391S
Burn of third degree of multiple sites of right shoulder and upper limb, except wrist and hand,
T22.392A
Burn of third degree of multiple sites of left shoulder and upper limb, except wrist and hand, initial
T22.392D
Burn of third degree of multiple sites of left shoulder and upper limb, except wrist and hand,
T22.392S
Burn of third degree of multiple sites of left shoulder and upper limb, except wrist and hand, sequela T22.399A
Burn of third degree of multiple sites of unspecified shoulder and upper limb, except wrist and hand,
T22.399D
Burn of third degree of multiple sites of unspecified shoulder and upper limb, except wrist and hand,
T22.399S,
Burn of third degree of multiple sites of unspecified shoulder and upper limb, except wrist and hand,
T23.201A
Burn of second degree of right hand, unspecified site, initial encounter T23.201D
Burn of second degree of right hand, unspecified site, subsequent encounter T23.201S
Burn of second degree of right hand, unspecified site, sequela T23.202A
Burn of second degree of left hand, unspecified site, initial encounter T23.202D
Burn of second degree of left hand, unspecified site, subsequent encounter T23.202S
Burn of second degree of left hand, unspecified site, sequela T23.209A
Burn of second degree of unspecified hand, unspecified site, initial encounter T23.209D
Burn of second degree of unspecified hand, unspecified site, subsequent encounter T23.209S
Burn of second degree of unspecified hand, unspecified site, sequela T23.211A
Burn of second degree of right thumb (nail), initial encounter T23.211D
Burn of second degree of right thumb (nail), subsequent encounter T23.211S
Burn of second degree of right thumb (nail), sequela T23.212A
Burn of second degree of left thumb (nail), initial encounter T23.212D
Burn of second degree of left thumb (nail), subsequent encounter T23.212S
Burn of second degree of left thumb (nail), sequela T23.219A
Burn of second degree of unspecified thumb (nail), initial encounter T23.219D
Burn of second degree of unspecified thumb (nail), subsequent encounter T23.219S
Burn of second degree of unspecified thumb (nail), sequela T23.221A
Burn of second degree of single right finger (nail) except thumb, initial encounter T23.221D
Burn of second degree of single right finger (nail) except thumb, subsequent encounter T23.221S
Burn of second degree of single right finger (nail) except thumb, sequela T23.222A
Burn of second degree of single left finger (nail) except thumb, initial encounter T23.222D
Burn of second degree of single left finger (nail) except thumb, subsequent encounter T23.222S
Burn of second degree of single left finger (nail) except thumb, sequela

Page 29 of 39 T23.229A
Burn of second degree of unspecified single finger (nail) except thumb, initial encounter T23.229D
Burn of second degree of unspecified single finger (nail) except thumb, subsequent encounter T23.229S
Burn of second degree of unspecified single finger (nail) except thumb, sequela T23.231A
Burn of second degree of multiple right fingers (nail), not including thumb, initial encounter T23.231D
Burn of second degree of multiple right fingers (nail), not including thumb, subsequent encounter T23.231S
Burn of second degree of multiple right fingers (nail), not including thumb, sequela T23.232A
Burn of second degree of multiple left fingers (nail), not including thumb, initial encounter T23.232D
Burn of second degree of multiple left fingers (nail), not including thumb, subsequent encounter T23.232S
Burn of second degree of multiple left fingers (nail), not including thumb, sequela T23.239A
Burn of second degree of unspecified multiple fingers (nail), not including thumb, initial encounter T23.239D
Burn of second degree of unspecified multiple fingers (nail), not including thumb, subsequent
T23.239S
Burn of second degree of unspecified multiple fingers (nail), not including thumb, sequela T23.241A
Burn of second degree of multiple right fingers (nail), including thumb, initial encounter T23.241D
Burn of second degree of multiple right fingers (nail), including thumb, subsequent encounter T23.241S
Burn of second degree of multiple right fingers (nail), including thumb, sequela T23.242A
Burn of second degree of multiple left fingers (nail), including thumb, initial encounter T23.242D
Burn of second degree of multiple left fingers (nail), including thumb, subsequent encounter T23.242S
Burn of second degree of multiple left fingers (nail), including thumb, sequela T23.249A
Burn of second degree of unspecified multiple fingers (nail), including thumb, initial encounter T23.249D
Burn of second degree of unspecified multiple fingers (nail), including thumb, subsequent encounter T23.249S
Burn of second degree of unspecified multiple fingers (nail), including thumb, sequela T23.251A
Burn of second degree of right palm, initial encounter T23.251D
Burn of second degree of right palm, subsequent encounter T23.251S
Burn of second degree of right palm, sequela T23.252A
Burn of second degree of left palm, initial encounter T23.252D
Burn of second degree of left palm, subsequent encounter T23.252S
Burn of second degree of left palm, sequela T23.259A
Burn of second degree of unspecified palm, initial encounte T23.259D
Burn of second degree of unspecified palm, subsequent encounter T23.259S
Burn of second degree of unspecified palm, sequela T23.261A
Burn of second degree of back of right hand, initial encounter T23.261D
Burn of second degree of back of right hand, subsequent encounter T23.261S
Burn of second degree of back of right hand, sequela T23.262A
Burn of second degree of back of left hand, initial encounter T23.262D
Burn of second degree of back of left hand, subsequent encounter T23.262S
Burn of second degree of back of left hand, sequela

Page 30 of 39 T23.269A
Burn of second degree of back of unspecified hand, initial encounter T23.269D
Burn of second degree of back of unspecified hand, subsequent encounter T23.269S
Burn of second degree of back of unspecified hand, sequela T23.271A
Burn of second degree of right wrist, initial encounter T23.271D
Burn of second degree of right wrist, subsequent encounter T23.271S
Burn of second degree of right wrist, sequela T23.272A
Burn of second degree of left wrist, initial encounter T23.272D
Burn of second degree of left wrist, subsequent encounter T23.272S
Burn of second degree of left wrist, sequela T23.279A
Burn of second degree of unspecified wrist, initial encounter T23.279D
Burn of second degree of unspecified wrist, subsequent encounter T23.279S
Burn of second degree of unspecified wrist, sequela T23.291A
Burn of second degree of multiple sites of right wrist and hand, initial encounter T23.291D
Burn of second degree of multiple sites of right wrist and hand, subsequent encounter T23.291S
Burn of second degree of multiple sites of right wrist and hand, sequela T23.292A
Burn of second degree of multiple sites of left wrist and hand, initial encounter T23.292D
Burn of second degree of multiple sites of left wrist and hand, subsequent encounter T23.292S
Burn of second degree of multiple sites of left wrist and hand, sequela T23.299A
Burn of second degree of multiple sites of unspecified wrist and hand, initial encounter T23.299D
Burn of second degree of multiple sites of unspecified wrist and hand, subsequent encounter T23.299S
Burn of second degree of multiple sites of unspecified wrist and hand, sequela T23.301A
Burn of third degree of right hand, unspecified site, initial encounter T23.301D
Burn of third degree of right hand, unspecified site, subsequent encounter T23.301S
Burn of third degree of right hand, unspecified site, sequela T23.302A
Burn of third degree of left hand, unspecified site, initial encounter T23.302D
Burn of third degree of left hand, unspecified site, subsequent encounter T23.302S
Burn of third degree of left hand, unspecified site, sequela T23.309A
Burn of third degree of unspecified hand, unspecified site, initial encounter T23.309D
Burn of third degree of unspecified hand, unspecified site, subsequent encounter T23.309S
Burn of third degree of unspecified hand, unspecified site, sequela T23.311A
Burn of third degree of right thumb (nail), initial encounter T23.311D
Burn of third degree of right thumb (nail), subsequent encounter T23.311S
Burn of third degree of right thumb (nail), sequela T23.312A
Burn of third degree of left thumb (nail), initial encounter T23.312D
Burn of third degree of left thumb (nail), subsequent encounter T23.312S
Burn of third degree of left thumb (nail), sequela

Page 31 of 39 T23.319A
Burn of third degree of unspecified thumb (nail), initial encounter T23.319D
Burn of third degree of unspecified thumb (nail), subsequent encounter T23.319S
Burn of third degree of unspecified thumb (nail), sequela T23.321A
Burn of third degree of single right finger (nail) except thumb, initial encounter T23.321D
Burn of third degree of single right finger (nail) except thumb, subsequent encounter T23.321S
Burn of third degree of single right finger (nail) except thumb, sequela T23.322A
Burn of third degree of single left finger (nail) except thumb, initial encounter T23.322D
Burn of third degree of single left finger (nail) except thumb, subsequent encounter T23.322S
Burn of third degree of single left finger (nail) except thumb, sequela T23.329A
Burn of third degree of unspecified single finger (nail) except thumb, initial encounter T23.329D
Burn of third degree of unspecified single finger (nail) except thumb, subsequent encounter T23.329S
Burn of third degree of unspecified single finger (nail) except thumb, sequela T23.331A
Burn of third degree of multiple right fingers (nail), not including thumb, initial encounter T23.331D
Burn of third degree of multiple right fingers (nail), not including thumb, subsequent encounter T23.331S
Burn of third degree of multiple right fingers (nail), not including thumb, sequela T23.332A
Burn of third degree of multiple left fingers (nail), not including thumb, initial encounter T23.332D
Burn of third degree of multiple left fingers (nail), not including thumb, subsequent encounter T23.332S
Burn of third degree of multiple left fingers (nail), not including thumb, sequela T23.339A
Burn of third degree of unspecified multiple fingers (nail), not including thumb, initial encounter T23.339D
Burn of third degree of unspecified multiple fingers (nail), not including thumb, subsequent
T23.339S
Burn of third degree of unspecified multiple fingers (nail), not including thumb, sequela T23.341A
Burn of third degree of multiple right fingers (nail), including thumb, initial encounter T23.341D
Burn of third degree of multiple right fingers (nail), including thumb, subsequent encounter T23.341S
Burn of third degree of multiple right fingers (nail), including thumb, sequela T23.342A
Burn of third degree of multiple left fingers (nail), including thumb, initial encounter T23.342D
Burn of third degree of multiple left fingers (nail), including thumb, subsequent encounter T23.342S
Burn of third degree of multiple left fingers (nail), including thumb, sequela T23.349A
Burn of third degree of unspecified multiple fingers (nail), including thumb, initial encounter T23.349D
Burn of third degree of unspecified multiple fingers (nail), including thumb, subsequent encounter T23.349S
Burn of third degree of unspecified multiple fingers (nail), including thumb, sequela T23.351A
Burn of third degree of right palm, initial encounter T23.351D
Burn of third degree of right palm, subsequent encounter T23.351S
Burn of third degree of right palm, sequela T23.352A
Burn of third degree of left palm, initial encounter T23.352D
Burn of third degree of left palm, subsequent encounter T23.352S
Burn of third degree of left palm, sequela

Page 32 of 39 T23.359A
Burn of third degree of unspecified palm, initial encounter T23.359D
Burn of third degree of unspecified palm, subsequent encounter T23.359S
Burn of third degree of unspecified palm, sequela T23.361A
Burn of third degree of back of right hand, initial encounter T23.361D
Burn of third degree of back of right hand, subsequent encounter T23.361S
Burn of third degree of back of right hand, sequela T23.362A
Burn of third degree of back of left hand, initial encounter T23.362D
Burn of third degree of back of left hand, subsequent encounter T23.362S
Burn of third degree of back of left hand, sequel T23.369A
Burn of third degree of back of unspecified hand, initial encounter T23.369D
Burn of third degree of back of unspecified hand, subsequent encounter T23.369S
Burn of third degree of back of unspecified hand, sequela T23.371A
Burn of third degree of right wrist, initial encounter T23.371D
Burn of third degree of right wrist, subsequent encounter T23.371S
Burn of third degree of right wrist, sequela T23.372A
Burn of third degree of left wrist, initial encounter T23.372D
Burn of third degree of left wrist, subsequent encounter T23.372S
Burn of third degree of left wrist, sequela T23.379A
Burn of third degree of unspecified wrist, initial encounter T23.379D
Burn of third degree of unspecified wrist, subsequent encounter T23.379S
Burn of third degree of unspecified wrist, sequela T23.391A
Burn of third degree of multiple sites of right wrist and hand, initial encounter T23.391D
Burn of third degree of multiple sites of right wrist and hand, subsequent encounter T23.391S
Burn of third degree of multiple sites of right wrist and hand, sequela T23.392A
Burn of third degree of multiple sites of left wrist and hand, initial encounter T23.392D
Burn of third degree of multiple sites of left wrist and hand, subsequent encounter T23.392S
Burn of third degree of multiple sites of left wrist and hand, sequela T23.399A
Burn of third degree of multiple sites of unspecified wrist and hand, initial encounter T23.399D
Burn of third degree of multiple sites of unspecified wrist and hand, subsequent encounter T23.399S
Burn of third degree of multiple sites of unspecified wrist and hand, sequela T24.201A
Burn of second degree of unspecified site of right lower limb, except ankle and foot, initial encounter T24.201D
Burn of second degree of unspecified site of right lower limb, except ankle and foot, subsequent
T24.201S
Burn of second degree of unspecified site of right lower limb, except ankle and foot, sequela T24.202A
Burn of second degree of unspecified site of left lower limb, except ankle and foot, initial encounter T24.202D
Burn of second degree of unspecified site of left lower limb, except ankle and foot, subsequent
T24.202S
Burn of second degree of unspecified site of left lower limb, except ankle and foot, sequela

Page 33 of 39 T24.209A
Burn of second degree of unspecified site of unspecified lower limb, except ankle and foot, initial
T24.209D
Burn of second degree of unspecified site of unspecified lower limb, except ankle and foot,
T24.209S
Burn of second degree of unspecified site of unspecified lower limb, except ankle and foot, sequela T24.211A
Burn of second degree of right thigh, initial encounter T24.211D
Burn of second degree of right thigh, subsequent encounter T24.211S
Burn of second degree of right thigh, sequela T24.212A
Burn of second degree of left thigh, initial encounter T24.212D
Burn of second degree of left thigh, subsequent encounter T24.212S
Burn of second degree of left thigh, sequela T24.219A
Burn of second degree of unspecified thigh, initial encounter T24.219D
Burn of second degree of unspecified thigh, subsequent encounter T24.219S
Burn of second degree of unspecified thigh, sequela T24.221A
Burn of second degree of right knee, initial encounter T24.221D
Burn of second degree of right knee, subsequent encounter T24.221S
T24.221S Burn of second degree of right knee, sequel T24.222A
Burn of second degree of left knee, initial encounter T24.222D
Burn of second degree of left knee, subsequent encounter T24.222S
Burn of second degree of left knee, sequela T24.229A
Burn of second degree of unspecified knee, initial encounter T24.229D
Burn of second degree of unspecified knee, subsequent encounter T24.229S
Burn of second degree of unspecified knee, sequela T24.231A
Burn of second degree of right lower leg, initial encounter T24.231D
Burn of second degree of right lower leg, subsequent encounter T24.231S
Burn of second degree of right lower leg, sequela T24.232A
Burn of second degree of left lower leg, initial encounter T24.232D
Burn of second degree of left lower leg, subsequent encounter T24.232S
Burn of second degree of left lower leg, sequela T24.239A
Burn of second degree of unspecified lower leg, initial encounter T24.239D
Burn of second degree of unspecified lower leg, subsequent encounter T24.239S
Burn of second degree of unspecified lower leg, sequela T24.291A
Burn of second degree of multiple sites of right lower limb, except ankle and foot, initial encounter T24.291D
Burn of second degree of multiple sites of right lower limb, except ankle and foot, subsequent
T24.291S
Burn of second degree of multiple sites of right lower limb, except ankle and foot, sequela T24.292A
Burn of second degree of multiple sites of left lower limb, except ankle and foot, initial encounter T24.292D
Burn of second degree of multiple sites of left lower limb, except ankle and foot, subsequent
T24.292S
Burn of second degree of multiple sites of left lower limb, except ankle and foot, sequela

Page 34 of 39 T24.299A
Burn of second degree of multiple sites of unspecified lower limb, except ankle and foot, initial
T24.299D
Burn of second degree of multiple sites of unspecified lower limb, except ankle and foot,
T24.299S
Burn of second degree of multiple sites of unspecified lower limb, except ankle and foot, sequela T24.301A
Burn of third degree of unspecified site of right lower limb, except ankle and foot, initial encounter T24.301D
Burn of third degree of unspecified site of right lower limb, except ankle and foot, subsequent
T24.301S
Burn of third degree of unspecified site of right lower limb, except ankle and foot, sequela T24.302A
Burn of third degree of unspecified site of left lower limb, except ankle and foot, initial encounter T24.302D
Burn of third degree of unspecified site of left lower limb, except ankle and foot, subsequent
T24.302S
Burn of third degree of unspecified site of left lower limb, except ankle and foot, sequela T24.309A
Burn of third degree of unspecified site of unspecified lower limb, except ankle and foot, initial
T24.309D
Burn of third degree of unspecified site of unspecified lower limb, except ankle and foot, subsequent
T24.309S
Burn of third degree of unspecified site of unspecified lower limb, except ankle and foot, sequela T24.311A
Burn of third degree of right thigh, initial encounter T24.311D
Burn of third degree of right thigh, subsequent encounter T24.311S
Burn of third degree of right thigh, sequela T24.312A
Burn of third degree of left thigh, initial encounter T24.312D
Burn of third degree of left thigh, subsequent encounter T24.312S
Burn of third degree of left thigh, sequela T24.319A
Burn of third degree of unspecified thigh, initial encounter T24.319D
Burn of third degree of unspecified thigh, subsequent encounter T24.319S
Burn of third degree of unspecified thigh, sequela T24.321A
Burn of third degree of right knee, initial encounter T24.321D
Burn of third degree of right knee, subsequent encounter T24.321S
Burn of third degree of right knee, sequela T24.322A
Burn of third degree of left knee, initial encounter T24.322D
Burn of third degree of left knee, subsequent encounter T24.322S
Burn of third degree of left knee, sequela T24.329A
Burn of third degree of unspecified knee, initial encounter T24.329D
Burn of third degree of unspecified knee, subsequent encounter T24.329S
Burn of third degree of unspecified knee, sequela T24.331A
Burn of third degree of right lower leg, initial encounter T24.331D
Burn of third degree of right lower leg, subsequent encounter T24.331S
Burn of third degree of right lower leg, sequela T24.332A
Burn of third degree of left lower leg, initial encounter T24.332D
Burn of third degree of left lower leg, subsequent encounter T24.332S
Burn of third degree of left lower leg, sequela

Page 35 of 39 T24.339A
Burn of third degree of unspecified lower leg, initial encounter T24.339D
Burn of third degree of unspecified lower leg, subsequent encounter T24.339S
Burn of third degree of unspecified lower leg, sequela T24.391A
Burn of third degree of multiple sites of right lower limb, except ankle and foot, initial encounter T24.391D
Burn of third degree of multiple sites of right lower limb, except ankle and foot, subsequent
T24.391S
Burn of third degree of multiple sites of right lower limb, except ankle and foot, sequela T24.392A
Burn of third degree of multiple sites of left lower limb, except ankle and foot, initial encounter T24.392D
Burn of third degree of multiple sites of left lower limb, except ankle and foot, subsequent encounter T24.392S
Burn of third degree of multiple sites of left lower limb, except ankle and foot, sequela T24.399A
Burn of third degree of multiple sites of unspecified lower limb, except ankle and foot, initial
T24.399D
Burn of third degree of multiple sites of unspecified lower limb, except ankle and foot, subsequent
T24.399S
Burn of third degree of multiple sites of unspecified lower limb, except ankle and foot, sequela T25.211A
Burn of second degree of right ankle, initial encounter T25.211D
Burn of second degree of right ankle, subsequent encounter T25.211S
Burn of second degree of right ankle, sequela T25.212A
Burn of second degree of left ankle, initial encounter T25.212D
Burn of second degree of left ankle, subsequent encounter T25.212S
Burn of second degree of left ankle, sequela T25.219A
Burn of second degree of unspecified ankle, initial encounter T25.219D Burn of second degree of unspecified ankle, subsequent encounter T25.219S
Burn of second degree of unspecified ankle, sequela T25.221A
Burn of second degree of right foot, initial encounter T25.221D
Burn of second degree of right foot, subsequent encounter T25.221S
Burn of second degree of right foot, sequela T25.222A
Burn of second degree of left foot, initial encounter T25.222D
Burn of second degree of left foot, subsequent encounter T25.222S
Burn of second degree of left foot, sequela T25.229A
Burn of second degree of unspecified foot, initial encounter T25.229D
Burn of second degree of unspecified foot, subsequent encounter T25.229S
Burn of second degree of unspecified foot, sequela T25.231A
Burn of second degree of right toe(s) (nail), initial encounter T25.231D
Burn of second degree of right toe(s) (nail), subsequent encounter T25.231S
Burn of second degree of right toe(s) (nail), sequela T25.232A
Burn of second degree of left toe(s) (nail), initial encounter T25.232D
Burn of second degree of left toe(s) (nail), subsequent encounter T25.232S
Burn of second degree of left toe(s) (nail), sequela

Page 36 of 39 T25.239A
Burn of second degree of unspecified toe(s) (nail), initial encounter T25.239D
Burn of second degree of unspecified toe(s) (nail), subsequent encounter T25.239S
Burn of second degree of unspecified toe(s) (nail), sequela T25.291A
Burn of second degree of multiple sites of right ankle and foot, initial encounter T25.291D
Burn of second degree of multiple sites of right ankle and foot, subsequent encounter T25.291S
Burn of second degree of multiple sites of right ankle and foot, sequela T25.292A
Burn of second degree of multiple sites of left ankle and foot, initial encounter T25.292D
Burn of second degree of multiple sites of left ankle and foot, subsequent encounter T25.292S
Burn of second degree of multiple sites of left ankle and foot, sequela T25.299A
Burn of second degree of multiple sites of unspecified ankle and foot, initial encounter T25.299D
Burn of second degree of multiple sites of unspecified ankle and foot, subsequent encounter T25.299S
Burn of second degree of multiple sites of unspecified ankle and foot, sequela T25.311A
Burn of third degree of right ankle, initial encounter T25.311D
Burn of third degree of right ankle, subsequent encounter T25.311S
Burn of third degree of right ankle, sequela T25.312A
Burn of third degree of left ankle, initial encounter T25.312D
Burn of third degree of left ankle, subsequent encounter T25.312S
Burn of third degree of left ankle, sequela T25.319A
Burn of third degree of unspecified ankle, initial encounter T25.319D
Burn of third degree of unspecified ankle, subsequent encounter T25.319S
Burn of third degree of unspecified ankle, sequela T25.321A
Burn of third degree of right foot, initial encounter T25.321D
Burn of third degree of right foot, subsequent encounter T25.321S
Burn of third degree of right foot, sequela T25.322A
Burn of third degree of left foot, initial encounter T25.322D
Burn of third degree of left foot, subsequent encounter T25.322S
Burn of third degree of left foot, sequela T25.329A
Burn of third degree of unspecified foot, initial encounter T25.329D
Burn of third degree of unspecified foot, subsequent encounter T25.329S
Burn of third degree of unspecified foot, sequela T25.331A
Burn of third degree of right toe(s) (nail), initial encounter T25.331D
Burn of third degree of right toe(s) (nail), subsequent encounter T25.331S
Burn of third degree of right toe(s) (nail), sequela T25.332A
Burn of third degree of left toe(s) (nail), initial encounte T25.332D
Burn of third degree of left toe(s) (nail), subsequent encounter T25.332S
Burn of third degree of left toe(s) (nail), sequela

Page 37 of 39 T25.339A
Burn of third degree of unspecified toe(s) (nail), initial encounter T25.339D
Burn of third degree of unspecified toe(s) (nail), subsequent encounter T25.339S
Burn of third degree of unspecified toe(s) (nail), sequela T25.391A
Burn of third degree of multiple sites of right ankle and foot, initial encounter T25.391D
Burn of third degree of multiple sites of right ankle and foot, subsequent encounter T25.391S
Burn of third degree of multiple sites of right ankle and foot, sequela T25.392A
Burn of third degree of multiple sites of left ankle and foot, initial encounter T25.392D
Burn of third degree of multiple sites of left ankle and foot, subsequent encounter T25.392S
Burn of third degree of multiple sites of left ankle and foot, sequela T25.399A
Burn of third degree of multiple sites of unspecified ankle and foot, initial encounter T25.399D
Burn of third degree of multiple sites of unspecified ankle and foot, subsequent encounter T25.399S
Burn of third degree of multiple sites of unspecified ankle and foot, sequela T30.0 Burn of unspecified body region, unspecified degree T57.3X1A Toxic effect of hydrogen cyanide, accidental (unintentional), initial encounter T57.3X2A Toxic effect of hydrogen cyanide, intentional self-harm, initial encounter T57.3X3A Toxic effect of hydrogen cyanide, assault, initial encounter T57.3X4A Toxic effect of hydrogen cyanide, undetermined, initial encounter T58.01xA Toxic effect of carbon monoxide from motor vehicle exhaust, accidental (unintentional), initial encounter T58.02xA Toxic effect of carbon monoxide from motor vehicle exhaust, intentional self-harm, initial encounter T58.03xA Toxic effect of carbon monoxide from motor vehicle exhaust, assault, initial encounter T58.04xA Toxic effect of carbon monoxide from motor vehicle exhaust, undetermined, initial encounter T58.11xA Toxic effect of carbon monoxide from utility gas, accidental (unintentional), initial encounter T58.12xA Toxic effect of carbon monoxide from utility gas, intentional self-harm, initial encounter T58.13xA Toxic effect of carbon monoxide from utility gas, assault, initial encounter T58.14xA Toxic effect of carbon monoxide from utility gas, undetermined, initial encounter T58.2X1A Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, accidental (unintentional), initial encounter T58.2X2A Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, intentional self-harm, initial encounter T58.2X3A Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, assault, initial encounter T58.2X4A Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, undetermined, initial encounter T58.8X1A Toxic effect of carbon monoxide from other source, accidental (unintentional), initial encounter T58.8X2A Toxic effect of carbon monoxide from other source, intentional self-harm, initial encounter T58.8X3A Toxic effect of carbon monoxide from other source, assault, initial encounter T58.8X4A Toxic effect of carbon monoxide from other source, undetermined, initial encounter T58.91xA Toxic effect of carbon monoxide from unspecified source, accidental (unintentional), initial encounter

Page 38 of 39 T58.92xA Toxic effect of carbon monoxide from unspecified source, intentional self-harm, initial encounter T58.93xA Toxic effect of carbon monoxide from unspecified source, assault, initial encounter T58.94xA Toxic effect of carbon monoxide from unspecified source, undetermined, initial encounter T65.0X1A Toxic effect of cyanides, accidental (unintentional), initial encounter T65.0X2A Toxic effect of cyanides, intentional self-harm, initial encounter T65.0X3A Toxic effect of cyanides, assault, initial encounter T65.0X4A Toxic effect of cyanides, undetermined, initial encounter T66.xxxA Radiation sickness, unspecified, initial encounter T70.29XA Other effects of high altitude, initial encounter T70.3xxA Caisson disease [decompression sickness], initial encounter T79.0xxA Air embolism (traumatic), initial encounter T80.0xxA Air embolism following infusion, transfusion and therapeutic injection, initial encounter T86.820 Skin graft (allograft) rejection T86.821 Skin graft (allograft) (autograft) failure T86.822 Skin graft (allograft) (autograft) infection T86.828 Other complications of skin graft (allograft) (autograft) T86.829 Unspecified complication of skin graft (allograft) (autograft) T87.0X1 Complications of reattached (part of) right upper extremity T87.0X2 Complications of reattached (part of) left upper extremity T87.0X9 Complications of reattached (part of) unspecified upper extremity T87.1X1 Complications of reattached (part of) right lower extremity T87.1X2 Complications of reattached (part of) left lower extremity T87.1X9 Complications of reattached (part of) unspecified lower extremity T87.2 Complications of other reattached body part References Armstrong DG, Lavery LA, Kimbriel HR, Nixon BP, Boulton AJ. Activity patterns of patients with diabetic foot ulceration: patients with active ulceration may not adhere to a standard pressure off-loading regimen. Diabetes Care. 2003;26:2595-2597. Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB. Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care. 2001;24:1019-1022. Bennett MH, Kertesz T, Perleth M, et al. Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus. Cochrane Database Syst Rev. 2012c;10:CD004739.M. Wahl. Osteoradionecrosis prevention myths. International Journal of Radiation OncologyBiologyPhysics, 2006 Mar 1;64(3):661-9. Centers for Medicare & Medicaid Services. National Coverage Determination. Hyperbaric Oxygen Therapy. https://www.cms.gov/medicare-coverage- database/view/ncd.aspx?ncdid=12&ncdver=4&keyword=hyperbaric&keywordType=starts&areaId=s41&docType=NCA,CAL,NCD,ME DCAC,TA,MCD,6,3,5,1,F,P&contractOption=all&sortBy=relevance&bc=1. Accessed September 22, 2025. Maxymiw WG, Wood RE, Liu FF. Postradiation dental extractions without hyperbaric oxygen. Oral Surg Oral Med Oral Pathol. 1991 Sep;72(3):270-4.

Page 39 of 39 Sulaiman F, Huryn JM, Zlotolow IM. Dental extractions in the irradiated head and neck patient: a retrospective analysis of Memorial Sloan-Kettering Cancer Center protocols, criteria, and end results. J Oral Maxillofac Surg. 2003 Oct;61(10):1123-31. Wagner FW Jr. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle. 1981;2(2):64-122. Specialty-matched clinical peer review. Revision History Company(ies)

  DATE

REVISION EmblemHealth Sept. 12, 2025 Added avascular necrosis (aseptic osteonecrosis); central retinal artery occlusion; and thermal burns, second or third degree, as covered indications EmblemHealth ConnectiCare Sept. 13, 2024 Added “flaps” to the indication: Preparation and preservation of compromised skin grafts “and flaps” EmblemHealth ConnectiCare Sept. 8, 2023 Added emergent anemia and intracranial abscess as covered indications with clinical criteria
Removed exceptional blood loss anemia from Limitations/Exclusions
EmblemHealth ConnectiCare Oct. 14, 2022 Added post-concussive syndrome to list of conditions considered not medically necessary ConnectiCare Oct. 14, 2022 ConnectiCare adopts the clinical criteria of its parent corporation EmblemHealth

Book a walkthrough

Walk through this policy with us

Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.

GenHealth is the best way to run RCM including eligibility, prior auth, billing, and denials with AI that works like a teammate in your EMR and billing systems.

Downloa Form

Previewing the first 5 questions

Downloa

Indications

Sign up to see the rest of the questions

Walk through this policy with us

Choose how you'd like to learn more.

GenHealth is the best way to run RCM including eligibility, prior auth, billing, and denials with AI that works like a teammate in your EMR and billing systems.

Downloa Form

Previewing the first 5 questions

Downloa

Indications

Sign up to see the rest of the questions

Walk through this policy with us

Choose how you'd like to learn more.

Try GenHealth free.

Automate intake, eligibility, and PA with AI agents that work in your EMR and billing systems.