Allowable Covered Diagnosis Codes

50.4.1 – Allowable Covered Diagnosis Codes (Rev. 12435, Issued:12-28-23, Effective:01-29-24, Implementation:01-29-24) Deep Brain Stimulation is covered for the following diagnosis codes: If ICD-10-CM is applicable: • ICD-10-CM G20.A1 - Parkinson's disease without dyskinesia, without mention of fluctuations • ICD-10-CM G20.A2 - Parkinson's disease without dyskinesia, with fluctuations • ICD-10-CM G20.B1 - Parkinson's disease with dyskinesia, without mention of fluctuations • ICD-10 CM G20.B2 - Parkinson's disease with dyskinesia, with fluctuations • ICD-10-CM G20.C - Parkinsonism, unspecified • ICD-10-CM G25.0 - Essential tremor • ICD-10-CM G25.2 - Other specified form of tremor