LCD Reference Article Billing and Coding Article

Article - Billing and Coding: Non-Invasive Cerebrovascular Arterial

Studies (A52992)
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Contractor Information
CONTRACTOR NAME CONTRACT TYPE CONTRACT NUMBER JURISDICTION STATES

Novitas Solutions, Inc. A and B MAC 04111 - MAC A J-H Colorado

Novitas Solutions, Inc. A and B MAC 04112 - MAC B J-H Colorado

Novitas Solutions, Inc. A and B MAC 04211 - MAC A J-H New Mexico

Novitas Solutions, Inc. A and B MAC 04212 - MAC B J-H New Mexico

Novitas Solutions, Inc. A and B MAC 04311 - MAC A J-H Oklahoma

Novitas Solutions, Inc. A and B MAC 04312 - MAC B J-H Oklahoma

Novitas Solutions, Inc. A and B MAC 04411 - MAC A J-H Texas

Novitas Solutions, Inc. A and B MAC 04412 - MAC B J-H Texas

Novitas Solutions, Inc. A and B MAC 04911 - MAC A J-H Colorado

New Mexico
Oklahoma
Texas

Novitas Solutions, Inc. A and B MAC 07101 - MAC A J-H Arkansas

Novitas Solutions, Inc. A and B MAC 07102 - MAC B J-H Arkansas

Novitas Solutions, Inc. A and B MAC 07201 - MAC A J-H Louisiana

Novitas Solutions, Inc. A and B MAC 07202 - MAC B J-H Louisiana

Novitas Solutions, Inc. A and B MAC 07301 - MAC A J-H Mississippi

Novitas Solutions, Inc. A and B MAC 07302 - MAC B J-H Mississippi

Novitas Solutions, Inc. A and B MAC 12101 - MAC A J-L Delaware

Novitas Solutions, Inc. A and B MAC 12102 - MAC B J-L Delaware

Novitas Solutions, Inc. A and B MAC 12201 - MAC A J-L District of Columbia

Novitas Solutions, Inc. A and B MAC 12202 - MAC B J-L District of Columbia

Novitas Solutions, Inc. A and B MAC 12301 - MAC A J-L Maryland

Novitas Solutions, Inc. A and B MAC 12302 - MAC B J-L Maryland

Novitas Solutions, Inc. A and B MAC 12401 - MAC A J-L New Jersey

Novitas Solutions, Inc. A and B MAC 12402 - MAC B J-L New Jersey

Novitas Solutions, Inc. A and B MAC 12501 - MAC A J-L Pennsylvania

Created on 02/07/2024. Page 1 of 24

CONTRACTOR NAME CONTRACT TYPE CONTRACT NUMBER JURISDICTION STATES

Novitas Solutions, Inc. A and B MAC 12502 - MAC B J-L Pennsylvania

Novitas Solutions, Inc. A and B MAC 12901 - MAC A J-L Delaware

District of Columbia
Maryland
New Jersey
Pennsylvania

Article Information
General Information
Article ID AMA CPT / ADA CDT / AHA NUBC Copyright
A52992 Statement

CPT codes, descriptions and other data only are copyright 2023 American
Article Title Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Billing and Coding: Non-Invasive Cerebrovascular

Fee schedules, relative value units, conversion factors and/or related
Arterial Studies components are not assigned by the AMA, are not part of CPT, and the
AMA is not recommending their use. The AMA does not directly or indirectly
practice medicine or dispense medical services. The AMA assumes no
Article Type liability for data contained or not contained herein.
Billing and Coding
Current Dental Terminology © 2023 American Dental Association. All rights
reserved.
Original Effective Date
10/01/2015 Copyright © 2023, the American Hospital Association, Chicago, Illinois.
Reproduced with permission. No portion of the American Hospital
Association (AHA) copyrighted materials contained within this publication
Revision Effective Date may be copied without the express written consent of the AHA. AHA
copyrighted materials including the UB 04 codes and descriptions may not
08/02/2019
be removed, copied, or utilized within any software, product, service,
solution or derivative work without the written consent of the AHA. If an
entity wishes to utilize any AHA materials, please contact the AHA at 312
Revision Ending Date
893 6816.
N/A
Making copies or utilizing the content of the UB 04 Manual, including the
codes and/or descriptions, for internal purposes, resale and/or to be used
Retirement Date in any product or publication; creating any modified or derivative work of
N/A the UB 04 Manual and/or codes and descriptions; and/or making any
commercial use of UB 04 Manual or any portion thereof, including the
codes and/or descriptions, is only authorized with an express license from
the American Hospital Association. The American Hospital Association (the
"AHA") has not reviewed, and is not responsible for, the completeness or
accuracy of any information contained in this material, nor was the AHA or
any of its affiliates, involved in the preparation of this material, or the
analysis of information provided in the material. The views and/or positions
presented in the material do not necessarily represent the views of the
AHA. CMS and its products and services are not endorsed by the AHA or
any of its affiliates.

CMS National Coverage Policy

Please refer to the related LCD, L35397.

Created on 02/07/2024. Page 2 of 24

Article Guidance
Article Text

Coding Guidelines

Please refer to the Novitas Local Coverage Determination (LCD), Non-Invasive Cerebrovascular Arterial Studies,
L35397 for reasonable and necessary requirements and frequency limitations.

The HCPCS/CPT code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not
take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code
combinations prior to billing Medicare.

Note: When an uninterpretable study results in performing another type of study, only the successful study should
be billed.

When billing these procedures after a carotid endarterectomy, provide in the narrative the date of the surgery
and the verbiage "carotid endarterectomy."

Duplex post-interventional follow-up studies are typically limited in scope and unilateral in nature. The
"complete/bilateral" duplex scan codes should seldom be used, while the "unilateral or limited study" codes should be
used (except for the patient who had bilateral intervention).

Do not report procedure codes 93890-93893 in conjunction with code 93888.

All non-invasive vascular study CPT codes are considered bilateral codes unless otherwise indicated in the CPT
definition. The 150% payment adjustment for bilateral procedures does not apply. Modifier -50 and/or the anatomic
modifiers, -LT/-RT should not be used.

Append the modifier –52 to report a unilateral study as appropriate. Information explaining the reduced service
should be included in Item 19 of the CMS-1500 form or the electronic equivalent. Any appropriate documentation
may be submitted with the claim to support the reduced service.

Coding Information

CPT/HCPCS Codes

Group 1 Paragraph:

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes: (2 Codes)

CODE DESCRIPTION

93880 Extracranial bilat study

93882 Extracranial uni/ltd study

Created on 02/07/2024. Page 3 of 24

Group 2 Paragraph:

N/A

Group 2 Codes: (5 Codes)

CODE DESCRIPTION

93886 Intracranial complete study

93888 Intracranial limited study

93890 Tcd vasoreactivity study

93892 Tcd emboli detect w/o inj

93893 Tcd emboli detect w/inj

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1 Paragraph:

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the
ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Note: Use ICD-10-CM code I74.9 to report Paradoxical Cerebral Embolism.

Note: Use ICD-10-CM code R09.89 to report Carotid Bruit.

Note: Use ICD-10-CM code R22.1 to report Pulsatile Neck Mass.

Note: Use ICD-10-CM code R55 when findings and symptoms are consistent with cerebral vascular insufficiency
(vertebral, basilar and carotid artery reduced flow).

Medicare is establishing the following limited coverage for CPT codes 93880 and 93882:

Group 1 Codes: (329 Codes)

CODE DESCRIPTION

D44.6 Neoplasm of uncertain behavior of carotid body

D44.7 Neoplasm of uncertain behavior of aortic body and other paraganglia

G45.0 Vertebro-basilar artery syndrome

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CODE DESCRIPTION

G45.1 Carotid artery syndrome (hemispheric)

G45.2 Multiple and bilateral precerebral artery syndromes

G45.3 Amaurosis fugax

G45.4 Transient global amnesia

G45.8 Other transient cerebral ischemic attacks and related syndromes

G45.9 Transient cerebral ischemic attack, unspecified

G46.0 Middle cerebral artery syndrome

G46.1 Anterior cerebral artery syndrome

G46.2 Posterior cerebral artery syndrome

G46.3 Brain stem stroke syndrome

G46.4 Cerebellar stroke syndrome

G46.5 Pure motor lacunar syndrome

G46.6 Pure sensory lacunar syndrome

G46.7 Other lacunar syndromes

G46.8 Other vascular syndromes of brain in cerebrovascular diseases

G81.01 Flaccid hemiplegia affecting right dominant side

G81.02 Flaccid hemiplegia affecting left dominant side

G81.03 Flaccid hemiplegia affecting right nondominant side

G81.04 Flaccid hemiplegia affecting left nondominant side

G81.11 Spastic hemiplegia affecting right dominant side

G81.12 Spastic hemiplegia affecting left dominant side

G81.13 Spastic hemiplegia affecting right nondominant side

G81.14 Spastic hemiplegia affecting left nondominant side

G81.91 Hemiplegia, unspecified affecting right dominant side

G81.92 Hemiplegia, unspecified affecting left dominant side

G81.93 Hemiplegia, unspecified affecting right nondominant side

G81.94 Hemiplegia, unspecified affecting left nondominant side

G83.0 Diplegia of upper limbs

G83.11 Monoplegia of lower limb affecting right dominant side

G83.12 Monoplegia of lower limb affecting left dominant side

G83.13 Monoplegia of lower limb affecting right nondominant side

G83.14 Monoplegia of lower limb affecting left nondominant side

Created on 02/07/2024. Page 5 of 24

CODE DESCRIPTION

G83.21 Monoplegia of upper limb affecting right dominant side

G83.22 Monoplegia of upper limb affecting left dominant side

G83.23 Monoplegia of upper limb affecting right nondominant side

G83.24 Monoplegia of upper limb affecting left nondominant side

G83.31 Monoplegia, unspecified affecting right dominant side

G83.32 Monoplegia, unspecified affecting left dominant side

G83.33 Monoplegia, unspecified affecting right nondominant side

G83.34 Monoplegia, unspecified affecting left nondominant side

H34.01 Transient retinal artery occlusion, right eye

H34.02 Transient retinal artery occlusion, left eye

H34.03 Transient retinal artery occlusion, bilateral

H34.11 Central retinal artery occlusion, right eye

H34.12 Central retinal artery occlusion, left eye

H34.13 Central retinal artery occlusion, bilateral

H34.211 Partial retinal artery occlusion, right eye

H34.212 Partial retinal artery occlusion, left eye

H34.213 Partial retinal artery occlusion, bilateral

H34.231 Retinal artery branch occlusion, right eye

H34.232 Retinal artery branch occlusion, left eye

H34.233 Retinal artery branch occlusion, bilateral

H35.82 Retinal ischemia

H53.11 Day blindness

H53.121 Transient visual loss, right eye

H53.122 Transient visual loss, left eye

H53.123 Transient visual loss, bilateral

H53.131 Sudden visual loss, right eye

H53.132 Sudden visual loss, left eye

H53.133 Sudden visual loss, bilateral

I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris

I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with
documented spasm

Created on 02/07/2024. Page 6 of 24

CODE DESCRIPTION

I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina
pectoris

I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina
pectoris

I34.0 Nonrheumatic mitral (valve) insufficiency

I34.1 Nonrheumatic mitral (valve) prolapse

I34.2 Nonrheumatic mitral (valve) stenosis

I35.0 Nonrheumatic aortic (valve) stenosis

I35.1 Nonrheumatic aortic (valve) insufficiency

I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency

I61.0 Nontraumatic intracerebral hemorrhage in hemisphere, subcortical

I61.1 Nontraumatic intracerebral hemorrhage in hemisphere, cortical

I61.2 Nontraumatic intracerebral hemorrhage in hemisphere, unspecified

I61.3 Nontraumatic intracerebral hemorrhage in brain stem

I61.4 Nontraumatic intracerebral hemorrhage in cerebellum

I61.5 Nontraumatic intracerebral hemorrhage, intraventricular

I61.6 Nontraumatic intracerebral hemorrhage, multiple localized

I61.8 Other nontraumatic intracerebral hemorrhage

I61.9 Nontraumatic intracerebral hemorrhage, unspecified

I63.00 Cerebral infarction due to thrombosis of unspecified precerebral artery

I63.011 Cerebral infarction due to thrombosis of right vertebral artery

I63.012 Cerebral infarction due to thrombosis of left vertebral artery

I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries

I63.02 Cerebral infarction due to thrombosis of basilar artery

I63.031 Cerebral infarction due to thrombosis of right carotid artery

I63.032 Cerebral infarction due to thrombosis of left carotid artery

I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries

I63.09 Cerebral infarction due to thrombosis of other precerebral artery

I63.10 Cerebral infarction due to embolism of unspecified precerebral artery

I63.111 Cerebral infarction due to embolism of right vertebral artery

I63.112 Cerebral infarction due to embolism of left vertebral artery

I63.113 Cerebral infarction due to embolism of bilateral vertebral arteries

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CODE DESCRIPTION

I63.12 Cerebral infarction due to embolism of basilar artery

I63.131 Cerebral infarction due to embolism of right carotid artery

I63.132 Cerebral infarction due to embolism of left carotid artery

I63.133 Cerebral infarction due to embolism of bilateral carotid arteries

I63.19 Cerebral infarction due to embolism of other precerebral artery

CODE DESCRIPTION

I63.20 Cerebral infarction due to unspecified occlusion or stenosis of unspecified

precerebral arteries

I63.211 Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery

I63.212 Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery

I63.213 Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral

arteries

I63.219 Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral

artery

I63.22 Cerebral infarction due to unspecified occlusion or stenosis of basilar artery

I63.231 Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries

I63.232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries

I63.233 Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid

arteries

I63.29 Cerebral infarction due to unspecified occlusion or stenosis of other precerebral

arteries

I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery

I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery

I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries

I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery

I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery

I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries

I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery

I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery

I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries

I63.341 Cerebral infarction due to thrombosis of right cerebellar artery

I63.342 Cerebral infarction due to thrombosis of left cerebellar artery

I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries

Created on 02/07/2024. Page 8 of 24

CODE DESCRIPTION

I63.39 Cerebral infarction due to thrombosis of other cerebral artery

I63.411 Cerebral infarction due to embolism of right middle cerebral artery

I63.412 Cerebral infarction due to embolism of left middle cerebral artery

I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries

I63.421 Cerebral infarction due to embolism of right anterior cerebral artery

I63.422 Cerebral infarction due to embolism of left anterior cerebral artery

I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries

I63.431 Cerebral infarction due to embolism of right posterior cerebral artery

I63.432 Cerebral infarction due to embolism of left posterior cerebral artery

I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries

I63.441 Cerebral infarction due to embolism of right cerebellar artery

I63.442 Cerebral infarction due to embolism of left cerebellar artery

I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries

I63.49 Cerebral infarction due to embolism of other cerebral artery

I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral
artery

I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral
artery

I63.513 Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle

cerebral arteries

I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral
artery

I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral
artery

I63.523 Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior

cerebral arteries

I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior

cerebral artery

I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral
artery

I63.533 Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior

cerebral arteries

I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery

I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery

Created on 02/07/2024. Page 9 of 24

CODE DESCRIPTION

I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar

arteries

I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery

I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic

I63.81 Other cerebral infarction due to occlusion or stenosis of small artery

I63.89 Other cerebral infarction

I65.01 Occlusion and stenosis of right vertebral artery

I65.02 Occlusion and stenosis of left vertebral artery

I65.03 Occlusion and stenosis of bilateral vertebral arteries

I65.1 Occlusion and stenosis of basilar artery

I65.21 Occlusion and stenosis of right carotid artery

I65.22 Occlusion and stenosis of left carotid artery

I65.23 Occlusion and stenosis of bilateral carotid arteries

I65.8 Occlusion and stenosis of other precerebral arteries

I66.01 Occlusion and stenosis of right middle cerebral artery

I66.02 Occlusion and stenosis of left middle cerebral artery

I66.03 Occlusion and stenosis of bilateral middle cerebral arteries

I66.11 Occlusion and stenosis of right anterior cerebral artery

I66.12 Occlusion and stenosis of left anterior cerebral artery

I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries

I66.21 Occlusion and stenosis of right posterior cerebral artery

I66.22 Occlusion and stenosis of left posterior cerebral artery

I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries

I66.3 Occlusion and stenosis of cerebellar arteries

I66.8 Occlusion and stenosis of other cerebral arteries

I67.1 Cerebral aneurysm, nonruptured

I67.2 Cerebral atherosclerosis

I67.6 Nonpyogenic thrombosis of intracranial venous system

I67.81 Acute cerebrovascular insufficiency

I67.82 Cerebral ischemia

I67.841 Reversible cerebrovascular vasoconstriction syndrome

I67.848 Other cerebrovascular vasospasm and vasoconstriction

Created on 02/07/2024. Page 10 of 24

CODE DESCRIPTION

I67.89 Other cerebrovascular disease

I68.0 Cerebral amyloid angiopathy

I69.031 Monoplegia of upper limb following nontraumatic subarachnoid hemorrhage

affecting right dominant side

I69.032 Monoplegia of upper limb following nontraumatic subarachnoid hemorrhage

affecting left dominant side

I69.033 Monoplegia of upper limb following nontraumatic subarachnoid hemorrhage

affecting right non-dominant side

I69.034 Monoplegia of upper limb following nontraumatic subarachnoid hemorrhage

affecting left non-dominant side

I69.041 Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage affecting

right dominant side

I69.042 Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage affecting

left dominant side

I69.043 Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage affecting

right non-dominant side

I69.044 Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage affecting

left non-dominant side

I69.051 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage

affecting right dominant side

I69.052 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage

affecting left dominant side

I69.053 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage

affecting right non-dominant side

I69.054 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage

affecting left non-dominant side

I69.131 Monoplegia of upper limb following nontraumatic intracerebral hemorrhage affecting

right dominant side

I69.132 Monoplegia of upper limb following nontraumatic intracerebral hemorrhage affecting

left dominant side

I69.133 Monoplegia of upper limb following nontraumatic intracerebral hemorrhage affecting

right non-dominant side

I69.134 Monoplegia of upper limb following nontraumatic intracerebral hemorrhage affecting

left non-dominant side

I69.141 Monoplegia of lower limb following nontraumatic intracerebral hemorrhage affecting

right dominant side

I69.142 Monoplegia of lower limb following nontraumatic intracerebral hemorrhage affecting

Created on 02/07/2024. Page 11 of 24

CODE DESCRIPTION

left dominant side

I69.143 Monoplegia of lower limb following nontraumatic intracerebral hemorrhage affecting

right non-dominant side

I69.144 Monoplegia of lower limb following nontraumatic intracerebral hemorrhage affecting

left non-dominant side

CODE DESCRIPTION

I69.151 Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage

affecting right dominant side

I69.152 Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage

affecting left dominant side

I69.153 Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage

affecting right non-dominant side

I69.154 Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage

affecting left non-dominant side

I69.231 Monoplegia of upper limb following other nontraumatic intracranial hemorrhage

affecting right dominant side

I69.232 Monoplegia of upper limb following other nontraumatic intracranial hemorrhage

affecting left dominant side

I69.233 Monoplegia of upper limb following other nontraumatic intracranial hemorrhage

affecting right non-dominant side

I69.234 Monoplegia of upper limb following other nontraumatic intracranial hemorrhage

affecting left non-dominant side

I69.241 Monoplegia of lower limb following other nontraumatic intracranial hemorrhage

affecting right dominant side

I69.242 Monoplegia of lower limb following other nontraumatic intracranial hemorrhage

affecting left dominant side

I69.243 Monoplegia of lower limb following other nontraumatic intracranial hemorrhage

affecting right non-dominant side

I69.244 Monoplegia of lower limb following other nontraumatic intracranial hemorrhage

affecting left non-dominant side

I69.251 Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage

affecting right dominant side

I69.252 Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage

affecting left dominant side

I69.253 Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage

affecting right non-dominant side

I69.254 Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage

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CODE DESCRIPTION

affecting left non-dominant side

I69.331 Monoplegia of upper limb following cerebral infarction affecting right dominant side

I69.332 Monoplegia of upper limb following cerebral infarction affecting left dominant side

I69.333 Monoplegia of upper limb following cerebral infarction affecting right non-dominant
side

I69.334 Monoplegia of upper limb following cerebral infarction affecting left non-dominant
side

I69.341 Monoplegia of lower limb following cerebral infarction affecting right dominant side

I69.342 Monoplegia of lower limb following cerebral infarction affecting left dominant side

I69.343 Monoplegia of lower limb following cerebral infarction affecting right non-dominant
side

I69.344 Monoplegia of lower limb following cerebral infarction affecting left non-dominant
side

I69.351 Hemiplegia and hemiparesis following cerebral infarction affecting right dominant
side

I69.352 Hemiplegia and hemiparesis following cerebral infarction affecting left dominant side

I69.353 Hemiplegia and hemiparesis following cerebral infarction affecting right non-
dominant side

I69.354 Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant
side

I69.831 Monoplegia of upper limb following other cerebrovascular disease affecting right
dominant side

I69.832 Monoplegia of upper limb following other cerebrovascular disease affecting left
dominant side

I69.833 Monoplegia of upper limb following other cerebrovascular disease affecting right
non-dominant side

I69.834 Monoplegia of upper limb following other cerebrovascular disease affecting left non-
dominant side

I69.841 Monoplegia of lower limb following other cerebrovascular disease affecting right
dominant side

I69.842 Monoplegia of lower limb following other cerebrovascular disease affecting left
dominant side

I69.843 Monoplegia of lower limb following other cerebrovascular disease affecting right
non-dominant side

I69.844 Monoplegia of lower limb following other cerebrovascular disease affecting left non-
dominant side

Created on 02/07/2024. Page 13 of 24

CODE DESCRIPTION

I69.851 Hemiplegia and hemiparesis following other cerebrovascular disease affecting right
dominant side

I69.852 Hemiplegia and hemiparesis following other cerebrovascular disease affecting left
dominant side

I69.853 Hemiplegia and hemiparesis following other cerebrovascular disease affecting right
non-dominant side

I69.854 Hemiplegia and hemiparesis following other cerebrovascular disease affecting left
non-dominant side

I69.931 Monoplegia of upper limb following unspecified cerebrovascular disease affecting

right dominant side

I69.932 Monoplegia of upper limb following unspecified cerebrovascular disease affecting left
dominant side

I69.933 Monoplegia of upper limb following unspecified cerebrovascular disease affecting

right non-dominant side

I69.934 Monoplegia of upper limb following unspecified cerebrovascular disease affecting left
non-dominant side

I69.941 Monoplegia of lower limb following unspecified cerebrovascular disease affecting

right dominant side

I69.942 Monoplegia of lower limb following unspecified cerebrovascular disease affecting left
dominant side

I69.943 Monoplegia of lower limb following unspecified cerebrovascular disease affecting

right non-dominant side

I69.944 Monoplegia of lower limb following unspecified cerebrovascular disease affecting left
non-dominant side

I69.951 Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting

right dominant side

I69.952 Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting

left dominant side

I69.953 Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting

right non-dominant side

I69.954 Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting

left non-dominant side

I72.0 Aneurysm of carotid artery

I74.9 Embolism and thrombosis of unspecified artery

I76 Septic arterial embolism

I77.1 Stricture of artery

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CODE DESCRIPTION

I77.2 Rupture of artery

I77.3 Arterial fibromuscular dysplasia

I77.6 Arteritis, unspecified

I77.71 Dissection of carotid artery

I77.89 Other specified disorders of arteries and arterioles

R09.89 Other specified symptoms and signs involving the circulatory and respiratory
systems

R22.1 Localized swelling, mass and lump, neck

R26.0 Ataxic gait

R26.1 Paralytic gait

R29.5 Transient paralysis

R29.810 Facial weakness

R47.01 Aphasia

R47.02 Dysphasia

R47.1 Dysarthria and anarthria

R47.81 Slurred speech

R47.89 Other speech disturbances

R55 Syncope and collapse

S15.011A - S15.011S Minor laceration of right carotid artery, initial encounter - Minor laceration of right
carotid artery, sequela

S15.012A - S15.012S Minor laceration of left carotid artery, initial encounter - Minor laceration of left
carotid artery, sequela

S15.021A - S15.021S Major laceration of right carotid artery, initial encounter - Major laceration of right
carotid artery, sequela

S15.022A - S15.022S Major laceration of left carotid artery, initial encounter - Major laceration of left
carotid artery, sequela

S15.091A - S15.091S Other specified injury of right carotid artery, initial encounter - Other specified
injury of right carotid artery, sequela

S15.092A - S15.092S Other specified injury of left carotid artery, initial encounter - Other specified injury
of left carotid artery, sequela

S15.111A - S15.111S Minor laceration of right vertebral artery, initial encounter - Minor laceration of right
vertebral artery, sequela

S15.112A - S15.112S Minor laceration of left vertebral artery, initial encounter - Minor laceration of left
vertebral artery, sequela

Created on 02/07/2024. Page 15 of 24

CODE DESCRIPTION

S15.121A - S15.121S Major laceration of right vertebral artery, initial encounter - Major laceration of right
vertebral artery, sequela

S15.122A - S15.122S Major laceration of left vertebral artery, initial encounter - Major laceration of left
vertebral artery, sequela

S15.191A - S15.191S Other specified injury of right vertebral artery, initial encounter - Other specified
injury of right vertebral artery, sequela

S15.192A - S15.192S Other specified injury of left vertebral artery, initial encounter - Other specified
injury of left vertebral artery, sequela

S25.111A - S25.111S Minor laceration of right innominate or subclavian artery, initial encounter - Minor
laceration of right innominate or subclavian artery, sequela

S25.112A - S25.112S Minor laceration of left innominate or subclavian artery, initial encounter - Minor
laceration of left innominate or subclavian artery, sequela

S25.121A - S25.121S Major laceration of right innominate or subclavian artery, initial encounter - Major
laceration of right innominate or subclavian artery, sequela

S25.122A - S25.122S Major laceration of left innominate or subclavian artery, initial encounter - Major
laceration of left innominate or subclavian artery, sequela

S25.191A - S25.191S Other specified injury of right innominate or subclavian artery, initial encounter -
Other specified injury of right innominate or subclavian artery, sequela

S25.192A - S25.192S Other specified injury of left innominate or subclavian artery, initial encounter -
Other specified injury of left innominate or subclavian artery, sequela

Z09 Encounter for follow-up examination after completed treatment for conditions other
than malignant neoplasm

Group 2 Paragraph:

Note: Use ICD-10-CM code G93.89 to report assessment of Suspected Brain Death.

Note: Use ICD-10-CM code I74.9 to report Paradoxical Cerebral Embolism.

Note: Use ICD-10-CM code R55 when findings and symptoms are consistent with cerebral vascular insufficiency
(vertebral, basilar and carotid artery reduced flow).

Medicare is establishing the following limited coverage for CPT codes 93886, 93888, 93890, 93892, and
93893:

Group 2 Codes: (168 Codes)

CODE DESCRIPTION

G45.0 Vertebro-basilar artery syndrome

G45.2 Multiple and bilateral precerebral artery syndromes

G45.3 Amaurosis fugax

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CODE DESCRIPTION

G45.4 Transient global amnesia

G45.8 Other transient cerebral ischemic attacks and related syndromes

G45.9 Transient cerebral ischemic attack, unspecified

G46.0 Middle cerebral artery syndrome

G46.1 Anterior cerebral artery syndrome

G46.2 Posterior cerebral artery syndrome

G93.82 Brain death

G93.89 Other specified disorders of brain

G97.31 Intraoperative hemorrhage and hematoma of a nervous system organ or structure

complicating a nervous system procedure

G97.32 Intraoperative hemorrhage and hematoma of a nervous system organ or structure

complicating other procedure

G97.48 Accidental puncture and laceration of other nervous system organ or structure
during a nervous system procedure

G97.49 Accidental puncture and laceration of other nervous system organ or structure
during other procedure

G97.51 Postprocedural hemorrhage of a nervous system organ or structure following a

nervous system procedure

G97.52 Postprocedural hemorrhage of a nervous system organ or structure following other

procedure

I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery

I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery

I60.2 Nontraumatic subarachnoid hemorrhage from anterior communicating artery

I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery

I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery

I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery

I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery

I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery

I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries

I60.8 Other nontraumatic subarachnoid hemorrhage

I61.0 Nontraumatic intracerebral hemorrhage in hemisphere, subcortical

I61.1 Nontraumatic intracerebral hemorrhage in hemisphere, cortical

I61.3 Nontraumatic intracerebral hemorrhage in brain stem

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CODE DESCRIPTION

I61.4 Nontraumatic intracerebral hemorrhage in cerebellum

I61.5 Nontraumatic intracerebral hemorrhage, intraventricular

I61.6 Nontraumatic intracerebral hemorrhage, multiple localized

I61.8 Other nontraumatic intracerebral hemorrhage

I63.011 Cerebral infarction due to thrombosis of right vertebral artery

I63.012 Cerebral infarction due to thrombosis of left vertebral artery

I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries

I63.02 Cerebral infarction due to thrombosis of basilar artery

I63.031 Cerebral infarction due to thrombosis of right carotid artery

I63.032 Cerebral infarction due to thrombosis of left carotid artery

I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries

I63.09 Cerebral infarction due to thrombosis of other precerebral artery

I63.111 Cerebral infarction due to embolism of right vertebral artery

I63.112 Cerebral infarction due to embolism of left vertebral artery

I63.113 Cerebral infarction due to embolism of bilateral vertebral arteries

I63.12 Cerebral infarction due to embolism of basilar artery

I63.131 Cerebral infarction due to embolism of right carotid artery

I63.132 Cerebral infarction due to embolism of left carotid artery

I63.133 Cerebral infarction due to embolism of bilateral carotid arteries

I63.19 Cerebral infarction due to embolism of other precerebral artery

I63.211 Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery

I63.212 Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery

I63.213 Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral

arteries

I63.22 Cerebral infarction due to unspecified occlusion or stenosis of basilar artery

I63.231 Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries

I63.232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries

I63.233 Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid

arteries

I63.29 Cerebral infarction due to unspecified occlusion or stenosis of other precerebral

arteries

I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery

I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery

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CODE DESCRIPTION

I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries

I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery

I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery

I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries

I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery

I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery

I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries

I63.341 Cerebral infarction due to thrombosis of right cerebellar artery

I63.342 Cerebral infarction due to thrombosis of left cerebellar artery

I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries

I63.39 Cerebral infarction due to thrombosis of other cerebral artery

I63.411 Cerebral infarction due to embolism of right middle cerebral artery

I63.412 Cerebral infarction due to embolism of left middle cerebral artery

I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries

I63.421 Cerebral infarction due to embolism of right anterior cerebral artery

I63.422 Cerebral infarction due to embolism of left anterior cerebral artery

I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries

I63.431 Cerebral infarction due to embolism of right posterior cerebral artery

I63.432 Cerebral infarction due to embolism of left posterior cerebral artery

I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries

I63.441 Cerebral infarction due to embolism of right cerebellar artery

I63.442 Cerebral infarction due to embolism of left cerebellar artery

I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries

I63.49 Cerebral infarction due to embolism of other cerebral artery

I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral
artery

I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral
artery

I63.513 Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle

cerebral arteries

I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral
artery

I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral

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CODE DESCRIPTION

artery

I63.523 Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior

cerebral arteries

I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior

cerebral artery

I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral
artery

I63.533 Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior

cerebral arteries

I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery

I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery

I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar

arteries

I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery

I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic

I63.81 Other cerebral infarction due to occlusion or stenosis of small artery

I63.89 Other cerebral infarction

I63.9 Cerebral infarction, unspecified

CODE DESCRIPTION

I65.01 Occlusion and stenosis of right vertebral artery

I65.02 Occlusion and stenosis of left vertebral artery

I65.03 Occlusion and stenosis of bilateral vertebral arteries

I65.1 Occlusion and stenosis of basilar artery

I65.21 Occlusion and stenosis of right carotid artery

I65.22 Occlusion and stenosis of left carotid artery

I65.23 Occlusion and stenosis of bilateral carotid arteries

I65.8 Occlusion and stenosis of other precerebral arteries

I66.01 Occlusion and stenosis of right middle cerebral artery

I66.02 Occlusion and stenosis of left middle cerebral artery

I66.03 Occlusion and stenosis of bilateral middle cerebral arteries

I66.11 Occlusion and stenosis of right anterior cerebral artery

I66.12 Occlusion and stenosis of left anterior cerebral artery

I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries

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CODE DESCRIPTION

I66.21 Occlusion and stenosis of right posterior cerebral artery

I66.22 Occlusion and stenosis of left posterior cerebral artery

I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries

I66.3 Occlusion and stenosis of cerebellar arteries

I66.8 Occlusion and stenosis of other cerebral arteries

I67.1 Cerebral aneurysm, nonruptured

I67.2 Cerebral atherosclerosis

I67.7 Cerebral arteritis, not elsewhere classified

I67.81 Acute cerebrovascular insufficiency

I67.82 Cerebral ischemia

I67.841 Reversible cerebrovascular vasoconstriction syndrome

I67.848 Other cerebrovascular vasospasm and vasoconstriction

I67.89 Other cerebrovascular disease

I67.9 Cerebrovascular disease, unspecified

I72.6 Aneurysm of vertebral artery

I74.9 Embolism and thrombosis of unspecified artery

I76 Septic arterial embolism

Q28.2 Arteriovenous malformation of cerebral vessels

Q28.3 Other malformations of cerebral vessels

R26.0 Ataxic gait

R26.1 Paralytic gait

R26.81 Unsteadiness on feet

R26.89 Other abnormalities of gait and mobility

R29.5 Transient paralysis

R29.810 Facial weakness

R47.01 Aphasia

R47.02 Dysphasia

R47.1 Dysarthria and anarthria

R47.81 Slurred speech

R47.89 Other speech disturbances

R55 Syncope and collapse

S09.0XXA - S09.0XXS Injury of blood vessels of head, not elsewhere classified, initial encounter - Injury of

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CODE DESCRIPTION

blood vessels of head, not elsewhere classified, sequela

S15.111A - S15.111S Minor laceration of right vertebral artery, initial encounter - Minor laceration of right
vertebral artery, sequela

S15.112A - S15.112S Minor laceration of left vertebral artery, initial encounter - Minor laceration of left
vertebral artery, sequela

S15.121A - S15.121S Major laceration of right vertebral artery, initial encounter - Major laceration of right
vertebral artery, sequela

S15.122A - S15.122S Major laceration of left vertebral artery, initial encounter - Major laceration of left
vertebral artery, sequela

S15.191A - S15.191S Other specified injury of right vertebral artery, initial encounter - Other specified
injury of right vertebral artery, sequela

S15.192A - S15.192S Other specified injury of left vertebral artery, initial encounter - Other specified
injury of left vertebral artery, sequela

Z09 Encounter for follow-up examination after completed treatment for conditions other
than malignant neoplasm

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1 Paragraph:

All ICD-10 codes not listed under the "ICD-10 Codes that Support Medical Necessity" section of this article.

Group 1 Codes: (1 Code)

CODE DESCRIPTION

XX000 Not Applicable

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.
Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all
Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally
to all claims.

CODE DESCRIPTION

011x Hospital Inpatient (Including Medicare Part A)

012x Hospital Inpatient (Medicare Part B only)

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 CODE DESCRIPTION

013x Hospital Outpatient

083x Ambulatory Surgery Center

085x Critical Access Hospital

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report
this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services
reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all
Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to
apply equally to all Revenue Codes.

Note:The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes
included in this article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type
and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue
Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Publication 100-04, Medicare
Claims Processing Manual, for further guidance.

CODE DESCRIPTION

0921 Other Diagnostic Services - Peripheral Vascular Lab

Other Coding Information

N/A

Revision History Information

REVISION REVISION REVISION HISTORY EXPLANATION
HISTORY HISTORY
DATE NUMBER

08/02/2019 R4
Article revised and published on 10/17/2019 effective for dates of service on and after
08/02/2019. The following ICD-10-CM codes have been added to Group 1 ICD-10-CM
codes in the article: I25.110, I25.111, I25.118, I25.119. System changes have been
made to our articles in response to CMS Change Request 10901. The Coding Section
has been reordered and new sections for CPT/HCPCS Modifiers and Other Coding
Information have been added.

03/21/2019 R3
Article revised and published on 03/21/2019. All codes from L35397, Non-Invasive
Cerebrovascular Arterial Studies, have been placed in this article per CMS Change
Request 10901. Article title changed to clarify that the Article is providing billing and

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REVISION REVISION REVISION HISTORY EXPLANATION
HISTORY HISTORY
DATE NUMBER

coding information.

12/01/2016 R2 Article revised and published on 12/01/2016 to update the coding guidelines section
consistent with LCD L35397 Non-Invasive Cerebrovascular Arterial Studies and to add
the hyperlink to LCD L35397 to the Related Local Coverage Document(s) section.

10/01/2015 R1 10/01/2014 New article for those providers in the states of Arkansas, Louisiana,
Mississippi, Colorado, Texas, Oklahoma, and New Mexico. Article revised for the
states of Pennsylvania, Maryland, Delaware, District of Columbia, and New Jersey to
change reference to related LCD from L34854 to L35397 (Article Published
07/24/2014).

Associated Documents
Related Local Coverage Documents

LCDs
L35397 - Non-Invasive Cerebrovascular Arterial Studies

Related National Coverage Documents

N/A

Statutory Requirements URLs

N/A

Rules and Regulations URLs

N/A

CMS Manual Explanations URLs

N/A

Other URLs

N/A

Public Versions

UPDATED ON EFFECTIVE DATES STATUS

Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

10/11/2019 08/02/2019 - N/A Currently in Effect (This Version)

Keywords
N/A

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