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Diagnostic Doppler Sonography Benefits to Change for Texas Medicaid February 1, 2020

Last updated on 12/13/2019

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective for dates of service on or after February 1, 2020, diagnostic doppler sonography benefits will change for Texas Medicaid.

Overview of Benefit Changes

Changes to this medical benefit include the following:

  • Additional payable provider types for some services
  • Diagnosis code updates

Additional Payable Provider Types

The technical component for procedure codes 93886, 93888, 93890, 93892, and 93893 will be added as a benefit for physician providers when provided in the office setting.

Diagnosis Code Updates

Diagnosis code limitations will change for diagnostic doppler studies. New diagnosis codes will be added and some currently payable diagnosis codes will no longer be allowed. Below is a summary of all diagnosis limitations that will be effective for dates of service on or after February 1, 2020.

Extracranial Arterial Doppler Studies

Procedure codes 93880 and 93882 will be limited to the following diagnosis codes:

Diagnosis Codes

D446

D447

D7821

D7822

G450

G451

G452

G453

G454

G458

G459

G460

G461

G462

G463

G464

G465

G466

G467

G468

G8101

G8102

G8103

G8104

G8111

G8112

G8113

G8114

G8191

G8192

G8193

G8194

G830

G8311

G8312

G8313

G8314

G8321

G8322

G8323

G8324

G8331

G8332

G8333

G8334

G9751

G9752

G9761

G9762

H3401

H3402

H3403

H3411

H3412

H3413

H34211

H34212

H34213

H34231

H34232

H34233

H3582

H5311

H53121

H53122

H53123

H53131

H53132

H53133

H59311

H59312

H59313

H59319

H59321

H59322

H59323

H59329

H59331

H59332

H59333

H59339

H59341

H59342

H59343

H59349

H9541

H9542

H9551

H9552

I2510

I340

I341

I342

I350

I351

I352

I610

I611

I612

I613

I614

I615

I616

I618

I619

I6300

I63011

I63012

I63013

I6302

I63031

I63032

I63033

I6309

I6310

I63111

I63112

I63113

I6312

I63131

I63132

I63133

I6319

I6320

I63211

I63212

I63213

I63219

I6322

I63231

I63232

I63233

I6329

I63311

I63312

I63313

I63321

I63322

I63323

I63331

I63332

I63333

I63341

I63342

I63343

I6339

I63411

I63412

I63413

I63421

I63422

I63423

I63431

I63432

I63433

I63441

I63442

I63443

I6349

I63511

I63512

I63513

I63521

I63522

I63523

I63531

I63532

I63533

I63541

I63542

I63543

I6359

I636

I638

I6501

I6502

I6503

I651

I6521

I6522

I6523

I658

I6601

I6602

I6603

I6611

I6612

I6613

I6621

I6622

I6623

I663

I668

I671

I672

I676

I6781

I6782

I67841

I67848

I6789

I680

I69031

I69032

I69033

I69034

I69041

I69042

I69043

I69044

I69051

I69052

I69053

I69054

I69131

I69132

I69133

I69134

I69141

I69142

I69143

I69144

I69151

I69152

I69153

I69154

I69231

I69232

I69233

I69234

I69241

I69242

I69243

I69244

I69251

I69252

I69253

I69254

I69331

I69332

I69333

I69334

I69341

I69342

I69343

I69344

I69351

I69352

I69353

I69354

I69831

I69832

I69833

I69834

I69841

I69842

I69843

I69844

I69851

I69852

I69853

I69854

I69931

I69932

I69933

I69934

I69941

I69942

I69943

I69944

I69951

I69952

I69953

I69954

I720

I749

I76

I771

I772

I773

I776

I7771

I7789

I97610

I97611

I97618

I97620

I97621

I97630

I97631

I97638

J95830

J95831

J95860

J95861

K9161

K91840

K91841

K91870

K91871

L7621

L7622

L7631

L7632

M96830

M96831

M96840

M96841

N99820

N99821

N99840

N99841

R0989

R221

R260

R261

R295

R29810

R4701

R4702

R471

R4781

R4789

R55

S15011A

S15011D

S15011S

S15012A

S15012D

S15012S

S15021A

S15021D

S15021S

S15022A

S15022D

S15022S

S15091A

S15091D

S15091S

S15092A

S15092D

S15092S

S15111A

S15111D

S15111S

S15112A

S15112D

S15112S

S15121A

S15121D

S15121S

S15122A

S15122D

S15122S

S15191A

S15191D

S15191S

S15192A

S15192D

S15192S

S25111A

S25111D

S25111S

S25112A

S25112D

S25112S

S25121A

S25121D

S25121S

S25122A

S25122D

S25122S

S25191A

S25191D

S25191S

S25192A

S25192D

S25192S

T82817A

T82817D

T82817S

T82818A

T82818D

T82818S

T82827A

T82827D

T82827S

T82828A

T82828D

T82828S

T82837A

T82837D

T82837S

T82838A

T82838D

T82838S

T82847A

T82847D

T82847S

T82848A

T82848D

T82848S

T82857A

T82857D

T82857S

T82858A

T82858D

T82858S

T82867A

T82867D

T82867S

T82868A

T82868D

T82868S

T8381XA

T8381XD

T8381XS

T8382XA

T8382XD

T8382XS

T8383XA

T8383XD

T8383XS

T8384XA

T8384XD

T8384XS

T8385XA

T8385XD

T8385XS

T8386XA

T8386XD

T8386XS

T85818A

T85818D

T85818S

T85828A

T85828D

T85828S

T85838A

T85838D

T85838S

T85848A

T85848D

T85848S

T85858A

T85858D

T85858S

T85868A

T85868D

T85868S

T85898A

T85898D

T85898S

Z09

Z98890

The following diagnosis codes may be used as indicated below:

  • Use diagnosis code R0989 to report carotid bruit.
  • Use diagnosis code R221 to report pulsatile neck mass.
  • Use diagnosis code R55 when symptomatology indicates a strong clinical suspicion of vertebrobasilar insufficiency.

Transcranial Arterial Doppler Studies

Procedure codes 93886, 93888, 93890, 93892, and 93893 will be limited to the following diagnosis codes:

Diagnosis Codes

D7821

D7822

G450

G452

G453

G454

G458

G459

G460

G461

G462

G9382

G9389

G9731

G9732

G9748

G9749

G9751

G9752

G9761

G9762

H59311

H59312

H59313

H59319

H59321

H59322

H59323

H59329

H59331

H59332

H59333

H59339

H59341

H59342

H59343

H59349

H9541

H9542

H9551

H9552

I6011

I6012

I602

I6031

I6032

I604

I6051

I6052

I606

I608

I610

I611

I613

I614

I615

I616

I618

I63011

I63012

I63013

I6302

I63031

I63032

I63033

I6309

I63111

I63112

I63113

I6312

I63131

I63132

I63133

I6319

I63211

I63212

I63213

I6322

I63231

I63232

I63233

I6329

I63311

I63312

I63313

I63321

I63322

I63323

I63331

I63332

I63333

I63341

I63342

I63343

I6339

I63411

I63412

I63413

I63421

I63422

I63423

I63431

I63432

I63433

I63441

I63442

I63443

I6349

I63511

I63512

I63513

I63521

I63522

I63523

I63531

I63532

I63533

I63541

I63542

I63543

I6359

I636

I638

I639

I6501

I6502

I6503

I651

I6521

I6522

I6523

I658

I6601

I6602

I6603

I6611

I6612

I6613

I6621

I6622

I6623

I663

I668

I671

I672

I677

I6781

I6782

I67841

I67848

I6789

I679

I726

I749

I76

I97610

I97611

I97618

I97620

I97621

I97630

I97631

I97638

J95830

J95831

J95860

J95861

K9161

K91840

K91841

K91870

K91871

L7621

L7622

L7631

L7632

M96830

M96831

M96840

M96841

N99820

N99821

N99840

N99841

Q282

Q283

R260

R261

R2681

R2689

R295

R29810

R4701

R4702

R471

R4781

R4789

R55

S090XXA

S090XXD

S090XXS

S15111A

S15111D

S15111S

S15112A

S15112D

S15112S

S15121A

S15121D

S15121S

S15122A

S15122D

S15122S

S15191A

S15191D

S15191S

S15192A

S15192D

S15192S

T82818A

T82818D

T82818S

T82828A

T82828D

T82828S

T82838A

T82838D

T82838S

T82848A

T82848D

T82848S

T82858A

T82858D

T82858S

T82868A

T82868D

T82868S

Z09

The following diagnosis codes may be used as indicated below:

  • Use diagnosis code G9389 to identify assessment of suspected brain death.
  • Use diagnosis code I749 to report paradoxical cerebral embolism.
  • Use diagnosis code R55 when symptomatology indicates a strong clinical suspicion of vertebrobasilar insufficiency.

In addition to the diagnosis codes listed in the table above, procedure codes 93886 and 93888 are benefits for clients who are 2 through 16 years of age when submitted with the following diagnosis codes:

Diagnosis Codes

D5700

D5702

D571

D5720

D57212

D57219

D5780

D57812

D57819

Peripheral Arterial Doppler Studies

Procedure codes 93922, 93923, 93924, 93925, 93926, 93930, and 93931 will be limited to the following diagnosis codes:

Diagnosis Codes

E0851

E0852

E0859

E0951

E0952

E0959

E1051

E1052

E1059

E1151

E1152

E1159

E1351

E1352

E1359

G9751

G9752

I2583

I670

I700

I70218

I70228

I7025

I70268

I70298

I70418

I70428

I7045

I70468

I70498

I70518

I70528

I7055

I70568

I70598

I70618

I70628

I7065

I70668

I70698

I70718

I70728

I7075

I70768

I70798

I7092

I7101

I7102

I7103

I711

I712

I713

I714

I715

I716

I723

I728

I7300

I7301

I731

I7389

I739

I7401

I7409

I7411

I7419

I745

I748

I770

I771

I772

I773

I775

I7771

I7772

I7773

I7774

I7779

I77810

I77811

I77812

I7789

I790

I791

I798

I96

I97410

I97411

I97418

I9742

I9751

I9752

I97610

I97611

I97618

J9561

J9562

J9571

J9572

J95830

J95831

K9161

K9162

K9171

K9172

K91840

K91841

L7601

L7602

L7611

L7612

L7621

L7622

L89112

L89113

L89114

L89122

L89123

L89124

L89132

L89133

L89134

L89142

L89143

L89144

L89152

L89153

L89154

L89812

L89813

L89814

L89892

L89893

L89894

L98421

L98422

L98423

L98424

L98425

L98426

L98428

L98429

M314

M315

M316

M318

M79609

M96810

M96811

M96820

M96821

M96830

M96831

N183

N184

N185

N186

N9961

N9962

N9971

N9972

N99820

N99821

R0989

R1901

R1902

R1903

R1904

R1905

R1906

R1907

R1909

R200

R201

R202

R203

T801XXA

T801XXD

T801XXS

T8131XA

T8131XD

T8131XS

T8132XA

T8132XD

T8132XS

T81718A

T81718D

T81718S

T8172XA

T8172XD

T8172XS

T8189XA

T8189XD

T8189XS

T82310A

T82310D

T82310S

T82311A

T82311D

T82311S

T82312A

T82312D

T82312S

T82318A

T82318D

T82318S

T82320A

T82320D

T82320S

T82321A

T82321D

T82321S

T82322A

T82322D

T82322S

T82328A

T82328D

T82328S

T82330A

T82330D

T82330S

T82331A

T82331D

T82331S

T82332A

T82332D

T82332S

T82338A

T82338D

T82338S

T82390A

T82390D

T82390S

T82391A

T82391D

T82391S

T82392A

T82392D

T82392S

T82398A

T82398D

T82398S

T8241XA

T8241XD

T8241XS

T8242XA

T8242XD

T8242XS

T8243XA

T8243XD

T8243XS

T8249XA

T8249XD

T8249XS

T82510A

T82510D

T82510S

T82511A

T82511D

T82511S

T82513A

T82513D

T82513S

T82514A

T82514D

T82514S

T82515A

T82515D

T82515S

T82518A

T82518D

T82518S

T82520A

T82520D

T82520S

T82521A

T82521D

T82521S

T82523A

T82523D

T82523S

T82524A

T82524D

T82524S

T82525A

T82525D

T82525S

T82528A

T82528D

T82528S

T82530A

T82530D

T82530S

T82531A

T82531D

T82531S

T82533A

T82533D

T82533S

T82534A

T82534D

T82534S

T82535A

T82535D

T82535S

T82538A

T82538D

T82538S

T82590A

T82590D

T82590S

T82591A

T82591D

T82591S

T82593A

T82593D

T82593S

T82594A

T82594D

T82594S

T82595A

T82595D

T82595S

T82598A

T82598D

T82598S

T827XXA

T827XXD

T827XXS

T82817A

T82817D

T82817S

T82818A

T82818D

T82818S

T82827A

T82827D

T82827S

T82828A

T82828D

T82828S

T82837A

T82837D

T82837S

T82838A

T82838D

T82838S

T82847A

T82847D

T82847S

T82848A

T82848D

T82848S

T82856A

T82856D

T82856S

T82857A

T82857D

T82857S

T82858A

T82858D

T82858S

T82867A

T82867D

T82867S

T82868A

T82868D

T82868S

T82897A

T82897D

T82897S

T82898A

T82898D

T82898S

T8381XA

T8381XD

T8381XS

T8382XA

T8382XD

T8382XS

T8383XA

T8383XD

T8383XS

T8384XA

T8384XD

T8384XS

T8385XA

T8385XD

T8385XS

T8386XA

T8386XD

T8386XS

T8389XA

T8389XD

T8389XS

T8481XA

T8481XD

T8481XS

T8482XA

T8482XD

T8482XS

T8483XA

T8483XD

T8483XS

T8484XA

T8484XD

T8484XS

T8485XA

T8485XD

T8485XS

T8486XA

T8486XD

T8486XS

T8489XA

T8489XD

T8489XS

T85810A

T85810D

T85810S

T85818A

T85818D

T85818S

T85860A

T85860D

T85860S

T85868A

T85868D

T85868S

T8601

T8602

T8603

T8609

T8611

T8612

T8613

T8619

T8621

T8622

T8623

T86290

T86298

T8631

T8632

T8633

T8639

T8641

T8642

T8643

T8649

T86810

T86811

T86812

T86818

T86830

T86831

T86832

T86838

T86848

T86850

T86851

T86852

T86858

T86890

T86891

T86892

T86898

T872

T888XXA

Z09

Z4803

Z48812

Z4889

Z951

Z955

Z95820

Z95828

Z9861

Procedure codes 93922, 93923, 93930, and 93931 will also be a benefit when submitted with the following diagnosis codes for upper extremity conditions:

Diagnosis Codes

I721

I742

I75011

I75012

I75013

I7776

L89012

L89013

L89014

L89022

L89023

L89024

M79A11

M79A12

Q2731

S45011A

S45011D

S45011S

S45012A

S45012D

S45012S

S45091A

S45091D

S45091S

S45092A

S45092D

S45092S

S45111A

S45111D

S45111S

S45112A

S45112D

S45112S

S45191A

S45191D

S45191S

S45192A

S45192D

S45192S

S45211A

S45211D

S45211S

S45212A

S45212D

S45212S

S45219A

S45219D

S45219S

S45291A

S45291D

S45291S

S45292A

S45292D

S45292S

S45311A

S45311D

S45311S

S45312A

S45312D

S45312S

S45391A

S45391D

S45391S

S45392A

S45392D

S45392S

S45811A

S45811D

S45811S

S45812A

S45812D

S45812S

S45891A

S45891D

S45891S

S45892A

S45892D

S45892S

S55011A

S55011D

S55011S

S55012A

S55012D

S55012S

S55091A

S55091D

S55091S

S55092A

S55092D

S55092S

S55111A

S55111D

S55111S

S55112A

S55112D

S55112S

S55191A

S55191D

S55191S

S55192A

S55192D

S55192S

S55211A

S55211D

S55211S

S55212A

S55212D

S55212S

S55291A

S55291D

S55291S

S55292A

S55292D

S55292S

S55811A

S55811D

S55811S

S55812A

S55812D

S55812S

S55891A

S55891D

S55891S

S55892A

S55892D

S55892S

S65011A

S65011D

S65011S

S65012A

S65012D

S65012S

S65091A

S65091D

S65091S

S65092A

S65092D

S65092S

S65111A

S65111D

S65111S

S65112A

S65112D

S65112S

S65191A

S65191D

S65191S

S65192A

S65192D

S65192S

S65211A

S65211D

S65211S

S65212A

S65212D

S65212S

S65291A

S65291D

S65291S

S65292A

S65292D

S65292S

S65311A

S65311D

S65311S

S65312A

S65312D

S65312S

S65391A

S65391D

S65391S

S65392A

S65392D

S65392S

S65411A

S65411D

S65411S

S65412A

S65412D

S65412S

S65491A

S65491D

S65491S

S65492A

S65492D

S65492S

S65510A

S65510D

S65510S

S65511A

S65511D

S65511S

S65512A

S65512D

S65512S

S65513A

S65513D

S65513S

S65514A

S65514D

S65514S

S65515A

S65515D

S65515S

S65516A

S65516D

S65516S

S65517A

S65517D

S65517S

S65518A

S65518D

S65518S

S65590A

S65590D

S65590S

S65591A

S65591D

S65591S

S65592A

S65592D

S65592S

S65593A

S65593D

S65593S

S65594A

S65594D

S65594S

S65595A

S65595D

S65595S

S65596A

S65596D

S65596S

S65597A

S65597D

S65597S

S65598A

S65598D

S65598S

S65811A

S65811D

S65811S

S65812A

S65812D

S65812S

S65891A

S65891D

S65891S

S65892A

S65892D

S65892S

T870X1

T870X2

Procedure codes 93922, 93923, 93924, 93925, and 93926 will also be a benefit when submitted with the following diagnosis codes for lower extremity conditions:

Diagnosis Codes

I70211

I70212

I70213

I70221

I70222

I70223

I70231

I70232

I70233

I70234

I70235

I70238

I70241

I70242

I70243

I70244

I70245

I70248

I70261

I70262

I70263

I70291

I70292

I70293

I70411

I70412

I70413

I70421

I70422

I70423

I70431

I70432

I70433

I70434

I70435

I70438

I70441

I70442

I70443

I70444

I70445

I70448

I70461

I70462

I70463

I70491

I70492

I70493

I70511

I70512

I70513

I70521

I70522

I70523

I70531

I70532

I70533

I70534

I70535

I70538

I70541

I70542

I70543

I70544

I70545

I70548

I70561

I70562

I70563

I70591

I70592

I70593

I70611

I70612

I70613

I70621

I70622

I70623

I70631

I70632

I70633

I70634

I70635

I70638

I70641

I70642

I70643

I70644

I70645

I70648

I70661

I70662

I70663

I70691

I70692

I70693

I70711

I70712

I70713

I70721

I70722

I70723

I70731

I70732

I70733

I70734

I70735

I70738

I70741

I70742

I70743

I70744

I70745

I70748

I70761

I70762

I70763

I70791

I70792

I70793

I724

I743

I75021

I75022

I75023

I7777

I83011

I83012

I83013

I83014

I83015

I83018

I83021

I83022

I83023

I83024

I83025

I83028

L89212

L89213

L89214

L89222

L89223

L89224

L89312

L89313

L89314

L89322

L89323

L89324

L8942

L8943

L8944

L89512

L89513

L89514

L89522

L89523

L89524

L89612

L89613

L89614

L89622

L89623

L89624

L97111

L97112

L97113

L97114

L97115

L97116

L97118

L97119

L97121

L97122

L97123

L97124

L97125

L97126

L97128

L97129

L97205

L97206

L97208

L97209

L97211

L97212

L97213

L97214

L97215

L97216

L97218

L97219

L97221

L97222

L97223

L97224

L97305

L97306

L97308

L97309

L97311

L97312

L97313

L97314

L97315

L97316

L97318

L97319

L97321

L97322

L97323

L97324

L97325

L97326

L97328

L97329

L97411

L97412

L97413

L97414

L97416

L97418

L97419

L97421

L97422

L97423

L97424

L97425

L97426

L97428

L97429

L97511

L97512

L97513

L97514

L97521

L97522

L97523

L97524

L97811

L97812

L97813

L97814

L97816

L97818

L97819

L97821

L97822

L97823

L97824

L98411

L98412

L98413

L98414

L98415

L98416

L98418

L98419

M79A21

M79A22

Q2732

S75011A

S75011D

S75011S

S75012A

S75012D

S75012S

S75021A

S75021D

S75021S

S75022A

S75022D

S75022S

S75091A

S75091D

S75091S

S75092A

S75092D

S75092S

S75111A

S75111D

S75111S

S75112A

S75112D

S75112S

S75121A

S75121D

S75121S

S75122A

S75122D

S75122S

S75191A

S75191D

S75191S

S75192A

S75192D

S75192S

S75211A

S75211D

S75211S

S75212A

S75212D

S75212S

S75221A

S75221D

S75221S

S75222A

S75222D

S75222S

S75291A

S75291D

S75291S

S75292A

S75292D

S75292S

S75811A

S75811D

S75811S

S75812A

S75812D

S75812S

S75891A

S75891D

S75891S

S75892A

S75892D

S75892S

S85011A

S85011D

S85011S

S85012A

S85012D

S85012S

S85091A

S85091D

S85091S

S85092A

S85092D

S85092S

S85141A

S85141D

S85141S

S85142A

S85142D

S85142S

S85151A

S85151D

S85151S

S85152A

S85152D

S85152S

S85171A

S85171D

S85171S

S85172A

S85172D

S85172S

S85181A

S85181D

S85181S

S85182A

S85182D

S85182S

S85211A

S85211D

S85211S

S85212A

S85212D

S85212S

S85291A

S85291D

S85291S

S85292A

S85292D

S85292S

S85311A

S85311D

S85311S

S85312A

S85312D

S85312S

S85391A

S85391D

S85391S

S85392A

S85392D

S85392S

S85411A

S85411D

S85411S

S85412A

S85412D

S85412S

S85491A

S85491D

S85491S

S85492A

S85492D

S85492S

S85511A

S85511D

S85511S

S85512A

S85512D

S85512S

S85591A

S85591D

S85591S

S85592A

S85592D

S85592S

S85811A

S85811D

S85811S

S85812A

S85812D

S85812S

S85891A

S85891D

S85891S

S85892A

S85892D

S85892S

S95011A

S95011D

S95011S

S95012A

S95012D

S95012S

S95091A

S95091D

S95091S

S95092A

S95092D

S95092S

S95111A

S95111D

S95111S

S95112A

S95112D

S95112S

S95191A

S95191D

S95191S

S95192A

S95192D

S95192S

S95211A

S95211D

S95211S

S95212A

S95212D

S95212S

S95291A

S95291D

S95291S

S95292A

S95292D

S95292S

S95811A

S95811D

S95811S

S95812A

S95812D

S95812S

S95891A

S95891D

S95891S

S95892A

S95892D

S95892S

T871X1

T871X2

Peripheral Venous Doppler Studies

Procedure codes 93970 and 93971 will be limited to the following diagnosis codes:

Diagnosis Codes

I2601

I2602

I2609

I2690

I2692

I2699

I749

I8001

I8002

I8003

I8011

I8012

I8013

I80211

I80212

I80213

I80221

I80222

I80223

I80231

I80232

I80233

I80291

I80292

I80293

I808

I821

I82220

I82411

I82412

I82413

I82421

I82422

I82423

I82431

I82432

I82433

I82441

I82442

I82443

I82491

I82492

I82493

I82511

I82512

I82513

I82521

I82522

I82523

I82531

I82532

I82533

I82541

I82542

I82543

I82591

I82592

I82593

I82611

I82612

I82613

I82621

I82622

I82623

I82711

I82712

I82713

I82721

I82722

I82723

I82811

I82812

I82813

I82890

I82891

I82A11

I82A12

I82A13

I82A21

I82A22

I82A23

I82C11

I82C12

I82C13

I82C21

I82C22

I82C23

I83011

I83012

I83013

I83014

I83015

I83018

I83021

I83022

I83023

I83024

I83025

I83028

I8311

I8312

I83211

I83212

I83213

I83214

I83215

I83218

I83221

I83222

I83223

I83224

I83225

I83228

I83811

I83812

I83813

I83891

I83892

I83893

I87001

I87002

I87003

I87011

I87012

I87013

I87021

I87022

I87023

I87031

I87032

I87033

I87091

I87092

I87093

I871

I872

I87311

I87312

I87313

I87321

I87322

I87323

I87331

I87332

I87333

I87391

I87392

I87393

I96

J80

J9600

J9601

J9602

J9690

L97111

L97112

L97113

L97114

L97115

L97116

L97118

L97119

L97121

L97122

L97123

L97124

L97125

L97126

L97128

L97129

L97211

L97212

L97213

L97214

L97215

L97216

L97218

L97219

L97221

L97222

L97223

L97224

L97225

L97226

L97228

L97229

L97311

L97312

L97313

L97314

L97315

L97316

L97318

L97319

L97321

L97322

L97323

L97324

L97325

L97326

L97328

L97329

L97411

L97412

L97413

L97414

L97415

L97416

L97418

L97419

L97421

L97422

L97423

L97424

L97425

L97426

L97428

L97429

L97511

L97512

L97513

L97514

L97515

L97516

L97518

L97519

L97521

L97522

L97523

L97524

L97525

L97526

L97528

L97529

L97811

L97812

L97813

L97814

L97815

L97816

L97818

L97819

L97821

L97822

L97823

L97824

L97825

L97826

L97828

L97829

M7121

M7122

M79601

M79602

M79604

M79605

M79621

M79622

M79631

M79632

M79641

M79642

M79644

M79645

M79651

M79652

M79661

M79662

M79671

M79672

M79674

M79675

O2221

O2222

O2223

O2231

O2232

O2233

O870

O871

O88211

O88212

O88213

O8822

O8823

Q2731

Q2732

Q278

R042

R0600

R0602

R0609

R0682

R071

R0781

R0782

R0789

R079

R2231

R2232

R2233

R2241

R2242

R2243

R600

R601

R609

T800XXA

T801XXA

T8172XA

T82817A

T82818A

T82827A

T82828A

T82837A

T82838A

T82847A

T82848A

T82857A

T82858A

T82867A

T82868A

T8381XA

T8382XA

T8383XA

T8384XA

T8385XA

T83868A

T85818A

T85828A

T85838A

T85848A

T85858A

T85868A

T85898A

In addition to the diagnosis codes listed in the table above, procedure code 93971 will also be a benefit when submitted with diagnosis code Z01810, Z01818, or Z09.

For more information, call the TMHP Contact Center at 800-925-9126.