US · guidance

CMS Pub. 100-04, ch. 32, § 60.5.2

Applicable Diagnosis Codes for A/B MACs (B)

activein force · 2026-08-25 – presentas-observed

For services furnished on or after the implementation of ICD-10 the applicable ICD-10-CM diagnosis codes for this

benefit are:

ICD-10-CM Code Code Description

D68.51 Activated protein C resistance

D68.52 Prothrombin gene mutation

D68.59 Other primary thrombophilia

D68.61 Antiphospholipid syndrome

D68.62 Lupus anticoagulant syndrome

I23.6 Thrombosis of atrium, auricular appendage, and ventricle as current

complications following acute myocardial infarction

I26.01 Septic pulmonary embolism with acute cor pulmonale

I26.09 Other pulmonary embolism with acute cor pulmonale

I26.90 Septic pulmonary embolism without acute cor pulmonale

I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale

I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale

I26.99 Other pulmonary embolism without acute cor pulmonale

I27.24 Chronic thromboembolic pulmonary hypertension

I27.82 Chronic pulmonary embolism

I48.0 Paroxysmal atrial fibrillation

I48.11 Longstanding persistent atrial fibrillation

I48.19 Other persistent atrial fibrillation

I48.21 Permanent atrial fibrillation

I67.6 Nonpyogenic thrombosis of intracranial venous system

I80.11 Phlebitis and thrombophlebitis of right femoral vein

I80.12 Phlebitis and thrombophlebitis of left femoral vein

I80.13 Phlebitis and thrombophlebitis of femoral vein, bilateral

I80.211 Phlebitis and thrombophlebitis of right iliac vein

I80.212 Phlebitis and thrombophlebitis of left iliac vein

I80.213 Phlebitis and thrombophlebitis of iliac vein, bilateral

I80.221 Phlebitis and thrombophlebitis of right popliteal vein

I80.222 Phlebitis and thrombophlebitis of left popliteal vein

I80.223 Phlebitis and thrombophlebitis of popliteal vein, bilateral

I80.231 Phlebitis and thrombophlebitis of right tibial vein

I80.232 Phlebitis and thrombophlebitis of left tibial vein

I80.233 Phlebitis and thrombophlebitis of tibial vein, bilateral

I80.241 Phlebitis and thrombophlebitis of right peroneal vein

I80.242 Phlebitis and thrombophlebitis of left peroneal vein

I80.243 Phlebitis and thrombophlebitis of peroneal vein, bilateral

I80.251 Phlebitis and thrombophlebitis of right calf muscular vein

I80.252 Phlebitis and thrombophlebitis of left calf muscular vein

I80.253 Phlebitis and thrombophlebitis of calf muscular vein, bilateral

I80.291 Phlebitis and thrombophlebitis of other deep vessels of right lower extremity

I80.292 Phlebitis and thrombophlebitis of other deep vessels of left lower extremity

I80.293 Phlebitis and thrombophlebitis of other deep vessels of lower extremity,

bilateral

I82.0 Budd-Chiari syndrome

I82.210 Acute embolism and thrombosis of superior vena cava

I82.211 Chronic embolism and thrombosis of superior vena cava

I82.220 Acute embolism and thrombosis of inferior vena cava

I82.221 Chronic embolism and thrombosis of inferior vena cava

I82.290 Acute embolism and thrombosis of other thoracic veins

I82.291 Chronic embolism and thrombosis of other thoracic veins

I82.3 Embolism and thrombosis of renal vein

I82.411 Acute embolism and thrombosis of right femoral vein

I82.412 Acute embolism and thrombosis of left femoral vein

I82.413 Acute embolism and thrombosis of femoral vein, bilateral

I82.421 Acute embolism and thrombosis of right iliac vein

I82.422 Acute embolism and thrombosis of left iliac vein

I82.423 Acute embolism and thrombosis of iliac vein, bilateral

I82.431 Acute embolism and thrombosis of right popliteal vein

I82.432 Acute embolism and thrombosis of left popliteal vein

I82.433 Acute embolism and thrombosis of popliteal vein, bilateral

I82.441 Acute embolism and thrombosis of right tibial vein

I82.442 Acute embolism and thrombosis of left tibial vein

I82.443 Acute embolism and thrombosis of tibial vein, bilateral

I82.451 Acute embolism and thrombosis of right peroneal vein

I82.452 Acute embolism and thrombosis of left peroneal vein

I82.453 Acute embolism and thrombosis of peroneal vein, bilateral

I82.461 Acute embolism and thrombosis of right calf muscular vein

I82.462 Acute embolism and thrombosis of left calf muscular vein

I82.463 Acute embolism and thrombosis of calf muscular vein, bilateral

I82.491 Acute embolism and thrombosis of other specified deep vein of right lower

extremity

I82.492 Acute embolism and thrombosis of other specified deep vein of left lower

extremity

I82.493 Acute embolism and thrombosis of other specified deep vein of lower

extremity, bilateral

I82.511 Chronic embolism and thrombosis of right femoral vein

I82.512 Chronic embolism and thrombosis of left femoral vein

I82.513 Chronic embolism and thrombosis of femoral vein, bilateral

I82.521 Chronic embolism and thrombosis of right iliac vein

I82.522 Chronic embolism and thrombosis of left iliac vein

I82.523 Chronic embolism and thrombosis of iliac vein, bilateral

I82.531 Chronic embolism and thrombosis of right popliteal vein

I82.532 Chronic embolism and thrombosis of left popliteal vein

I82.533 Chronic embolism and thrombosis of popliteal vein, bilateral

I82.541 Chronic embolism and thrombosis of right tibial vein

I82.542 Chronic embolism and thrombosis of left tibial vein

I82.543 Chronic embolism and thrombosis of tibial vein, bilateral

I82.551 Chronic embolism and thrombosis of right peroneal vein

I82.552 Chronic embolism and thrombosis of left peroneal vein

I82.553 Chronic embolism and thrombosis of peroneal vein, bilateral

I82.561 Chronic embolism and thrombosis of right calf muscular vein

I82.562 Chronic embolism and thrombosis of left calf muscular vein

I82.563 Chronic embolism and thrombosis of calf muscular vein, bilateral

I82.591 Chronic embolism and thrombosis of other specified deep vein of right lower

extremity

I82.592 Chronic embolism and thrombosis of other specified deep vein of left lower

extremity

I82.593 Chronic embolism and thrombosis of other specified deep vein of lower

extremity, bilateral

I82.621 Acute embolism and thrombosis of deep veins of right upper extremity

I82.622 Acute embolism and thrombosis of deep veins of left upper extremity

I82.623 Acute embolism and thrombosis of deep veins of upper extremity, bilateral

I82.721 Chronic embolism and thrombosis of deep veins of right upper extremity

I82.722 Chronic embolism and thrombosis of deep veins of left upper extremity

I82.723 Chronic embolism and thrombosis of deep veins of upper extremity, bilateral

I82.890 Acute embolism and thrombosis of other specified veins

I82.891 Chronic embolism and thrombosis of other specified veins

I82.A11 Acute embolism and thrombosis of right axillary vein

I82.A12 Acute embolism and thrombosis of left axillary vein

I82.A13 Acute embolism and thrombosis of axillary vein, bilateral

I82.A21 Chronic embolism and thrombosis of right axillary vein

I82.A22 Chronic embolism and thrombosis of left axillary vein

I82.A23 Chronic embolism and thrombosis of axillary vein, bilateral

I82.B11 Acute embolism and thrombosis of right subclavian vein

I82.B12 Acute embolism and thrombosis of left subclavian vein

I82.B13 Acute embolism and thrombosis of subclavian vein, bilateral

I82.B21 Chronic embolism and thrombosis of right subclavian vein

I82.B22 Chronic embolism and thrombosis of left subclavian vein

I82.B23 Chronic embolism and thrombosis of subclavian vein, bilateral

I82.C11 Acute embolism and thrombosis of right internal jugular vein

I82.C12 Acute embolism and thrombosis of left internal jugular vein

I82.C13 Acute embolism and thrombosis of internal jugular vein, bilateral

I82.C21 Chronic embolism and thrombosis of right internal jugular vein

I82.C22 Chronic embolism and thrombosis of left internal jugular vein

I82.C23 Chronic embolism and thrombosis of internal jugular vein, bilateral

O87.3 Cerebral venous thrombosis in the puerperium

Z79.01 Long term (current) use of anticoagulants

Z86.718 Personal history of other venous thrombosis and embolism

Z95.2 Presence of prosthetic heart valve

Coverage policy can be found in Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1,

section 190.11 PT/INR. (http://www.cms.hhs.gov/manuals/103_cov_determ/ncd103index.asp

History

(Rev.10881; Issued: 08-06-2021; Effective: 09-07-2021; Implementation: 09-07- 2021)

Provenance

Source: cms.gov
Retrieved: 2026-08-25
Edition: iom-2026-08-25
Content hash: 3c9a017b9f4f4cb1936e52a8205e519d59320af1381ccf4e2e3e671feb1ac4e0

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