US · guidance

CMS Pub. 100-04, ch. 32, § 80.6

Editing Instructions for A/B MACs (A)

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

Edit 1 - Implement diagnosis to procedure code edits to allow payment only for the LOPS codes,

G0245, G0246, and G0247 when submitted with one of the following ICD-10-CM diagnosis codes

If ICD-10-CM is applicable:

ICD-10-CM ICD-10 DX Description

E08.40 Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified

E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy

E09.40 Drug or chemical induced diabetes mellitus with neurological complications with diabetic n

E09.42 Drug or chemical induced diabetes mellitus with neurological complications with diabetic p

E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified

E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy

E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy

E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy

E10.44 Type 1 diabetes mellitus with diabetic amyotrophy

E10.49 Type 1 diabetes mellitus with other diabetic neurological complication

E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy

E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified

E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy

E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy

E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy

E11.44 Type 2 diabetes mellitus with diabetic amyotrophy

E11.49 Type 2 diabetes mellitus with other diabetic neurological complication

E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy

E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified

E13.41 Other specified diabetes mellitus with diabetic mononeuropathy

E13.42 Other specified diabetes mellitus with diabetic polyneuropathy

E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy

E13.44 Other specified diabetes mellitus with diabetic amyotrophy

E13.49 Other specified diabetes mellitus with other diabetic neurological complication

E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy

Deny these services when submitted without one of the appropriate diagnoses. Use the same

messages you currently use for procedure to diagnosis code denials. Edit 2 – Deny G0247 if it is

not submitted on the same claim as G0245 or G0246.

Use MSN 21.21 - This service was denied because Medicare only covers this service under certain

circumstances.

Use RA claim adjustment reason code 107 - The related or qualifying claim/service was not

identified on this claim. NOTE: Refer to the 835 Healthcare Policy Identification Segment (loop 2110

Service Payment Information REF), if present.

History

(Rev. 11021; Issued: 10-01-21; Effective: 10-29-21; Implementation: 10-29-21)

Provenance

Source: cms.gov
Retrieved: 2026-08-25
Edition: iom-2026-08-25
Content hash: b31677fcc4c30d56a3636618313e681ea12a05ad6c6220348bb99ebf430ddfa2

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