US · guidance
CMS Pub. 100-04, ch. 32, § 90.4
Edits
NOTE: Coverage for conditions other than those specifically designated as covered in
80.2 or specifically designated as non-covered in this section will be at the discretion of the
individual A/B MAC (B).
Appropriate diagnosis to procedure code edits should be implemented for the non-covered conditions and
services in 90.2 90.2.1, and 90.3 as applicable
As the ICD-10-CM codes E85.4, E85.81, E85.89, and E85.9
amyloidosis does not differentiate between primary and non-primary, A/B MACs (B) should perform prepay
reviews on all claims with a diagnosis of ICD-10-CM codes E85.4, E85.81, E85.89, and E85.9 and a HCPCS
procedure code of 38241 to determine whether payment is appropriate.
History
(Rev.11035, Issued:10-13-21, Effective: 11-17-21; Implementation: 11-17-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
5c8de2013ba9f1f6fe7fcc34764a53228d8b9ba4016967fa44d5907b33defc75
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