U-M Premier Care Therapy Diagnosis Codes - BCBSM
U-M Premier Care Primary (Major) Diagnosis Codes for Therapies
ICD-10 code Description
C00.2
Lip, unspecified vermillion border
C00.9
Malignant neoplasm of lip, unspecified
C02
Malignant neoplasm tongue
C02.1
Malignant neoplasm tip and lateral border of tongue
C02.3
Malignant neoplasm anterior two-thirds of tongue, part unspecified
C07
Malignant neoplasm of major salivary glands
C08.0
Malignant neoplasm submandibular gland
C04.9
Malignant neoplasm floor of mouth, part unspecified
C05.0
Malignant neoplasm hard palate
C05.1
Malignant neoplasm soft palate
C05.9
Malignant neoplasm plate, unspecified
C05.8
Malignant neoplasm of overlapping sites of palate
C06.2
Malignant neoplasm retromolar area
C06.9
Malignant neoplasm mouth, unspecified
C09.9
Malignant neoplasm of oropharynx
C09.8
Malignant neoplasm of overlapping sites of tonsil
C09.0
Malignant neoplasm tonsillar fossa
C11.9
Malignant neoplasm nasopharynx, unspecified
C13.0
Malignant neoplasm of hypopharynx
C12
Malignant neoplasm pyriform sinus
C13.9
Malignant neoplasm hypopharynx, unspecified
C14.0
Malignant neoplasm of other and ill-defined sites within the lip, oral cavity and pharynx
C14.2
Malignant neoplasm of waldeyer's ring
C14.8
Malignant neuroplasm of overlapping sites of lip, oral cavity and pharynx
C15.9
Malignant neoplasm esophagus, unspecified
C30.0
Malignant neoplasm of nasal cavities, middle ear and accessory sinuses
C31.0
Malignant neoplasm maxillary sinus
C31.1
Malignant neoplasm ethmoidal sinus
C31.2
Malignant neoplasm frontal sinus
C31.3
Malignant neoplasm sphenoidal sinus
C32.0
Malignant neoplasm of Larynx
C32.1
Malignant neoplasm supraglottis
C32.2
Malignant neoplasm subglottis
C32.9
Malignant neoplasm larynx, unspecified
Page 1 of 56
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U-M Premier Care Primary (Major) Diagnosis Codes for Therapies
ICD-10 code Description
C33
Malignant neoplasm of trachea, bronchus and lung
C34.00
Malignant neoplasm of unspecified main bronchus
C34.01
Malignant neoplasm of right main bronchus
C34.02
Malignant neuroplasm of left main bronchus
C34.10
Malignant neoplasm of upper lobe, unspecified main bronchus or lung
C34.11
Malignant neoplasm of upper lobe, right bronchus or lung
C34.12
Malignant neoplasm of upper lobe, left bronchus or lung
C34.2
Malignant neoplasm of middle lobe, bronchus or lung
C34.31
Malignant neoplasm of lower lobe, right bronchus or lung
C34.32
Malignant neoplasm of lower lobe, left bronchus or lung
C34.30
Malignant neoplasm of lower lobe, unspecified bronchus or lung
C34.80
Malignant neoplasm of overlapping sites of unspecified bronchus and lung
C34.82
Malignant neoplasm of overlapping sites of left bronchus and lung
C34.90
Malignant neoplasm of unspecified part of unspecified bronchus of lung
C34.91
Malignant neoplasm of unspecified part of right bronchus or lung
C34.92
Malignant neoplasm of unspecified part of left bronchus or lung
C41.0
Malignant neoplasm of bone and articular cartilage
C41.1
Malignant neoplasm mandible
C44.20
Malignant neoplasm of skin or unspecified ear and external auricular canal
C44.201 Malignant neoplasm skin of other and unspecified parts of face
C44.21
Malignant neoplasm of skin of right ear and external auricular canal
C44.22
Malignant neoplasm of skin of left ear and external aricular canal
C69.90
Malignant neoplasm eye, part unspecified
C69.91
Malignant neoplasm of unspecified site of right eye
C69.92
Malignant neoplasm of unspecified site or left eye
C71.0
Malignant neoplasm of the brain
C73
Malignant neoplasm of thyroid gland
C76.0
Malignant neoplasm of other and ill-defined sites within the lip, oral cavity and pharynx
C76.1
Malignant neoplasm of thorax
C76.2
Malignant neoplasm of abdomen
C76.3
Malignant neoplasm of pelvis
C76.40
Malignant neoplasm of unspecified upper limb
C76.41
Malignant neoplasm of right upper limb
C76.42
Malignant neoplasm of left upper limb
Page 2 of 56
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U-M Premier Care Primary (Major) Diagnosis Codes for Therapies
ICD-10 code Description
C76.50
Malignant neoplasm of unspecified lower limb
C76.51
Malignant neoplasm of right lower limb
C76.52
Malignant neoplasm of left lower limb
C76.8
Malignant neoplasm of other specified ill-defined sites
C457
Mesothelioma of other sites
C77.0
Secondary and unspecified malignant neoplasm of lymph nodes
C77.1
Secondary and unsp malignant neoplasm of intrathorac nodes
C77.2
Secondary and unsp malignant neoplasm of intra-abd nodes
C77.3
Sec and unsp malig neoplasm of axilla and upper limb nodes
C77.4
Sec and unsp malig neoplasm of inguinal and lower limb nodes
C77.5
Secondary and unsp malignant neoplasm of intrapelv nodes
C77.8
Sec and unsp malig neoplasm of nodes of multiple regions
C77.9
Secondary and unsp malignant neoplasm of lymph node, unsp
G12.9
Spinal muscular atrophy
G20
Parkinson's disease
G21.4
Vascular parkinsonism
G81.00
Flaccid hemiplegia affecting unspecified side
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
G81.10
Spastic hemiplegia affecting unspecified 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
G81.90
Hemiplegia unspecified affecting unspecified 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
G81.90
Hemiplegia unspecified affecting unspecified side
G81.91
Hemiplegia unspecified affecting right dominant side
G81.92
Hemiplegia unspecified affecting left dominant side
Page 3 of 56
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U-M Premier Care Primary (Major) Diagnosis Codes for Therapies
ICD-10 code Description
G81.93
Hemiplegia, unspecified affecting right nondominant side
G81.94
Hemiplegia, unspecified affecting left nondominant side
G82.20
Paraplegia
G04.1
Tropical spastic paraplegia
G82.21
Paraplegia, complete
G82.22
Paraplegia, incomplete
G93.1
Anoxic brain damage, not elsewhere classified
G93.40
Encephalopathy, unspecified
G93.41
Encephalopathy-metabolic
G93.49
Encephalopathy-other
G93.1
Encephalopathy-anoxic
G54.0
Nerve root and plexus disorders
G56.30
Mononeuritis of upper limb and monoeuritis multiplex lesion of radial nerve
G56.31
Lesion of radial nerve, right upper limb
G56.32
Lesion of radial nerve, left upper limb
G56.33
Lesion of radial nerve, bilateral upper limb
G61.0
Guillain-Bare syndrome
G61.81
Chronic inflammatory demyelinating polyneuritis
H90.3
Sensorineural hearing loss, bilateral
I60.00
Ntrm subarach hemorrhage from unsp carotid siphon and bifurc
I60.01
Ntrm subarach hemor from right carotid siphon and bifurc
I60.02
Ntrm subarach hemorrhage from left carotid siphon and bifurc
I60.10
Ntrm subarach hemorrhage from unsp middle cerebral artery
I60.11
Ntrm subarach hemorrhage from right middle cerebral artery
I60.12
Ntrm subarach hemorrhage from left middle cerebral artery
I60.30
Ntrm subarach hemor from unsp posterior communicating artery
I60.31
Ntrm subarach hemor from right post communicating artery
I60.32
Ntrm subarach hemor from left posterior communicating artery
I60.4
Nontraumatic subarachnoid hemorrhage from basilar artery
I60.50
Nontraumatic subarachnoid hemorrhage from unsp verteb art
I60.51
Nontraumatic subarachnoid hemorrhage from r verteb art
I60.52
Nontraumatic subarachnoid hemorrhage from l verteb art
I60.6
Nontraumatic subarachnoid hemorrhage from oth intracran art
I60.7
Nontraumatic subarachnoid hemorrhage from unsp intracran art
Page 4 of 56
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U-M Premier Care Primary (Major) Diagnosis Codes for Therapies
ICD-10 code Description
I60.8
Other nontraumatic subarachnoid hemorrhage
I60.9
Nontraumatic subarachnoid hemorrhage, unspecified
I61.0
Nontraumatic intracerebral hemorrhage in hemisphere cortical
I61.1
Nontraumatic intracerebral hemorrhage in hemisphere subcortical
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 inventraventricular
I61.6
Nontraumatic intracerebral hemorrhage, multiple localized
I61.8
Other nontraumatic intracerebral hemorrhage
I61.9
Nontraumatic intracerebral hemorrhage, unspecified
I63.50
Cereb infrc d/t unsp occls or stenos of unsp cereb art
I63.511
Cereb infrc d/t unsp occls or stenos of right mid cereb art
I63.512
Cereb infrc d/t unsp occls or stenos of left mid cereb art
I63.519
Cereb infrc d/t unsp occls or stenos of unsp mid cereb art
I63.521
Cereb infrc d/t unsp occls or stenos of right ant cereb art
I63.522
Cereb infrc d/t unsp occls or stenos of left ant cereb art
I63.529
Cereb infrc d/t unsp occls or stenos of unsp ant cereb art
I63.531
Cereb infrc d/t unsp occls or stenos of right post cereb art
I63.532
Cereb infrc d/t unsp occls or stenos of left post cereb art
I63.539
Cereb infrc d/t unsp occls or stenos of unsp post cereb art
I63.541
Cereb infrc due to unsp occls or stenos of right cereblr art
I63.542
Cereb infrc due to unsp occls or stenos of left cereblr art
I63.549
Cereb infrc due to unsp occls or stenos of unsp cereblr art
I63.59
Cereb infrc due to unsp occls or stenosis of cerebral artery
I63.8
Other cerebral infarction
I63.9
Cerebral infarction, unspecified
I97.2
Post mastectomy lymphedema syndrome
I89.0
Other Lymphedema
I89.1
Lymphangitis
I89.8
Other noninfectious disorders of lymphatic channels
I89.9
Unspecified noninfectious disorder of lymphatic channels
M27.8
Other specified diseases of the jaws
K13.1
Cheek and lip biting
Page 5 of 56
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U-M Premier Care Primary (Major) Diagnosis Codes for Therapies
ICD-10 code Description
K13.4
Granuloma and granuloma-like lesions of oral mucosa
K13.6
Irritative hyperplasia of oral mucosa
K13.70
Unspecified lesions of oral mucosa
K13.79
Other lesions of oral mucosa
M05.40
Rheumatoid myopathy with rheumatoid arthritis of unsp site
M05.411 Rheumatoid myopathy w rheumatoid arthritis of right shoulder
M05.412 Rheumatoid myopathy w rheumatoid arthritis of left shoulder
M05.419 Rheumatoid myopathy w rheumatoid arthritis of unsp shoulder
M05.421 Rheumatoid myopathy with rheumatoid arthritis of right elbow
M05.422 Rheumatoid myopathy with rheumatoid arthritis of left elbow
M05.429 Rheumatoid myopathy with rheumatoid arthritis of unsp elbow
M05.431 Rheumatoid myopathy with rheumatoid arthritis of right wrist
M05.432 Rheumatoid myopathy with rheumatoid arthritis of left wrist
M05.439 Rheumatoid myopathy with rheumatoid arthritis of unsp wrist
M05.441 Rheumatoid myopathy with rheumatoid arthritis of right hand
M05.442 Rheumatoid myopathy with rheumatoid arthritis of left hand
M05.449 Rheumatoid myopathy with rheumatoid arthritis of unsp hand
M05.451 Rheumatoid myopathy with rheumatoid arthritis of right hip
M05.452 Rheumatoid myopathy with rheumatoid arthritis of left hip
M05.459 Rheumatoid myopathy with rheumatoid arthritis of unsp hip
M05.461 Rheumatoid myopathy with rheumatoid arthritis of right knee
M05.462 Rheumatoid myopathy with rheumatoid arthritis of left knee
M05.469 Rheumatoid myopathy with rheumatoid arthritis of unsp knee
M05.471 Rheumatoid myopathy w rheumatoid arthritis of right ank/ft
M05.472 Rheumatoid myopathy w rheumatoid arthritis of left ank/ft
M05.479 Rheumatoid myopathy w rheumatoid arthritis of unsp ank/ft
M05.49
Rheumatoid myopathy w rheumatoid arthritis of multiple sites
M05.50
Rheumatoid polyneurop w rheumatoid arthritis of unsp site
M05.511 Rheumatoid polyneurop w rheumatoid arthritis of r shoulder
M05.512 Rheumatoid polyneurop w rheumatoid arthritis of l shoulder
M05.519 Rheu polyneurop w rheumatoid arthritis of unsp shoulder
M05.521 Rheumatoid polyneurop w rheumatoid arthritis of right elbow
M05.522 Rheumatoid polyneurop w rheumatoid arthritis of left elbow
M05.529 Rheumatoid polyneurop w rheumatoid arthritis of unsp elbow
Page 6 of 56
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U-M Premier Care Primary (Major) Diagnosis Codes for Therapies
ICD-10 code Description
M05.531 Rheumatoid polyneurop w rheumatoid arthritis of right wrist
M05.532 Rheumatoid polyneurop w rheumatoid arthritis of left wrist
M05.539 Rheumatoid polyneurop w rheumatoid arthritis of unsp wrist
M05.541 Rheumatoid polyneurop w rheumatoid arthritis of right hand
M05.542 Rheumatoid polyneurop w rheumatoid arthritis of left hand
M05.549 Rheumatoid polyneurop w rheumatoid arthritis of unsp hand
M05.551 Rheumatoid polyneurop w rheumatoid arthritis of right hip
M05.552 Rheumatoid polyneuropathy w rheumatoid arthritis of left hip
M05.559 Rheumatoid polyneuropathy w rheumatoid arthritis of unsp hip
M05.561 Rheumatoid polyneurop w rheumatoid arthritis of right knee
M05.562 Rheumatoid polyneurop w rheumatoid arthritis of left knee
M05.569 Rheumatoid polyneurop w rheumatoid arthritis of unsp knee
M05.571 Rheumatoid polyneurop w rheumatoid arthritis of right ank/ft
M05.572 Rheumatoid polyneurop w rheumatoid arthritis of left ank/ft
M05.579 Rheumatoid polyneurop w rheumatoid arthritis of unsp ank/ft
M05.59
Rheumatoid polyneuropathy w rheumatoid arthritis mult site
M05.70
Rheu arthritis w rheu factor of unsp site w/o org/sys involv
M05.711 Rheu arthritis w rheu factor of r shoulder w/o org/sys involv
M05.712 Rheu arthritis w rheu factor of l shoulder w/o org/sys involv
M05.719 Rheu arthritis w rheu factor of unsp shldr w/o org/sys involv
M05.721 Rheu arthritis w rheu factor of r elbow w/o org/sys involv
M05.722 Rheu arthritis w rheu factor of l elbow w/o org/sys involv
M05.729 Rheu arthritis w rheu factor of unsp elbow w/o org/sys involv
M05.731 Rheu arthritis w rheu factor of r wrist w/o org/sys involv
M05.732 Rheu arthritis w rheu factor of l wrist w/o org/sys involv
M05.739 Rheu arthritis w rheu factor of unsp wrist w/o org/sys involv
M05.741 Rheu arthritis w rheu factor of r hand w/o org/sys involv
M05.742 Rheu arthritis w rheu factor of left hand w/o org/sys involv
M05.749 Rheu arthritis w rheu factor of unsp hand w/o org/sys involv
M05.751 Rheu arthritis w rheu factor of right hip w/o org/sys involv
M05.752 Rheu arthritis w rheu factor of left hip w/o org/sys involv
M05.759 Rheu arthritis w rheu factor of unsp hip w/o org/sys involv
M05.761 Rheu arthritis w rheu factor of r knee w/o org/sys involv
M05.762 Rheu arthritis w rheu factor of left knee w/o org/sys involv
Page 7 of 56
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U-M Premier Care Primary (Major) Diagnosis Codes for Therapies
ICD-10 code Description
M05.769 Rheu arthritis w rheu factor of unsp knee w/o org/sys involv
M05.771 Rheu arthritis w rheu fctr of right ank/ft w/o org/sys involv
M05.772 Rheu arthritis w rheu factor of left ank/ft w/o org/sys involv
M05.779 Rheu arthritis w rheu factor of unsp ank/ft w/o org/sys involv
M05.79
Rheu arthritis w rheu factor mult site w/o org/sys involv
M05.80
Oth rheumatoid arthritis with rheumatoid factor of unsp site
M05.811 Oth rheumatoid arthritis w rheumatoid factor of r shoulder
M05.812 Oth rheumatoid arthritis w rheumatoid factor of l shoulder
M05.819 Oth rheu arthritis w rheumatoid factor of unsp shoulder
M05.821 Oth rheumatoid arthritis w rheumatoid factor of right elbow
M05.822 Oth rheumatoid arthritis w rheumatoid factor of left elbow
M05.829 Oth rheumatoid arthritis w rheumatoid factor of unsp elbow
M05.831 Oth rheumatoid arthritis w rheumatoid factor of right wrist
M05.832 Oth rheumatoid arthritis w rheumatoid factor of left wrist
M05.839 Oth rheumatoid arthritis w rheumatoid factor of unsp wrist
M05.841 Oth rheumatoid arthritis w rheumatoid factor of right hand
M05.842 Oth rheumatoid arthritis with rheumatoid factor of left hand
M05.849 Oth rheumatoid arthritis with rheumatoid factor of unsp hand
M05.851 Oth rheumatoid arthritis with rheumatoid factor of right hip
M05.852 Oth rheumatoid arthritis with rheumatoid factor of left hip
M05.859 Oth rheumatoid arthritis with rheumatoid factor of unsp hip
M05.861 Oth rheumatoid arthritis w rheumatoid factor of right knee
M05.862 Oth rheumatoid arthritis with rheumatoid factor of left knee
M05.869 Oth rheumatoid arthritis with rheumatoid factor of unsp knee
M05.871 Oth rheumatoid arthritis w rheumatoid factor of right ank/ft
M05.872 Oth rheumatoid arthritis w rheumatoid factor of left ank/ft
M05.879 Oth rheumatoid arthritis w rheumatoid factor of unsp ank/ft
M05.89
Oth rheumatoid arthritis w rheumatoid factor mult site
M05.9
Rheumatoid arthritis with rheumatoid factor, unspecified
M06.00
Rheumatoid arthritis without rheumatoid factor, unsp site
M06.011 Rheumatoid arthritis w/o rheumatoid factor, right shoulder
M06.012 Rheumatoid arthritis w/o rheumatoid factor, left shoulder
M06.019 Rheumatoid arthritis w/o rheumatoid factor, unsp shoulder
M06.021 Rheumatoid arthritis without rheumatoid factor, right elbow
Page 8 of 56
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