Limited Coverage ICD-10-PCS
The limited coverage edit is a coverage check in Medicare’s claim-validation software, the Medicare Code Editor (MCE). It covers the 49 ICD-10-PCS procedure codes listed below. For these complex, high-cost procedures, mostly organ transplants and heart assist systems, Medicare limits coverage to a portion of the cost rather than denying or fully paying the claim.
Procedure Codes in This Edit 49 codes · 5 categories
Heart and Great Vessels5 codes
- 02WA3QZ Revision of Implantable Heart Assist System in Heart, Percutaneous Approach
- 02WA4QZ Revision of Implantable Heart Assist System in Heart, Percutaneous Endoscopic Approach
- 02YA0Z0 Transplantation of Heart, Allogeneic, Open Approach
- 02YA0Z1 Transplantation of Heart, Syngeneic, Open Approach
- 02YA0Z2 Transplantation of Heart, Zooplastic, Open Approach
Respiratory System27 codes
- 0BYC0Z0 Transplantation of Right Upper Lung Lobe, Allogeneic, Open Approach
- 0BYC0Z1 Transplantation of Right Upper Lung Lobe, Syngeneic, Open Approach
- 0BYC0Z2 Transplantation of Right Upper Lung Lobe, Zooplastic, Open Approach
- 0BYD0Z0 Transplantation of Right Middle Lung Lobe, Allogeneic, Open Approach
- 0BYD0Z1 Transplantation of Right Middle Lung Lobe, Syngeneic, Open Approach
- 0BYD0Z2 Transplantation of Right Middle Lung Lobe, Zooplastic, Open Approach
- 0BYF0Z0 Transplantation of Right Lower Lung Lobe, Allogeneic, Open Approach
- 0BYF0Z1 Transplantation of Right Lower Lung Lobe, Syngeneic, Open Approach
- 0BYF0Z2 Transplantation of Right Lower Lung Lobe, Zooplastic, Open Approach
- 0BYG0Z0 Transplantation of Left Upper Lung Lobe, Allogeneic, Open Approach
- 0BYG0Z1 Transplantation of Left Upper Lung Lobe, Syngeneic, Open Approach
- 0BYG0Z2 Transplantation of Left Upper Lung Lobe, Zooplastic, Open Approach
- 0BYH0Z0 Transplantation of Lung Lingula, Allogeneic, Open Approach
- 0BYH0Z1 Transplantation of Lung Lingula, Syngeneic, Open Approach
- 0BYH0Z2 Transplantation of Lung Lingula, Zooplastic, Open Approach
- 0BYJ0Z0 Transplantation of Left Lower Lung Lobe, Allogeneic, Open Approach
- 0BYJ0Z1 Transplantation of Left Lower Lung Lobe, Syngeneic, Open Approach
- 0BYJ0Z2 Transplantation of Left Lower Lung Lobe, Zooplastic, Open Approach
- 0BYK0Z0 Transplantation of Right Lung, Allogeneic, Open Approach
- 0BYK0Z1 Transplantation of Right Lung, Syngeneic, Open Approach
- 0BYK0Z2 Transplantation of Right Lung, Zooplastic, Open Approach
- 0BYL0Z0 Transplantation of Left Lung, Allogeneic, Open Approach
- 0BYL0Z1 Transplantation of Left Lung, Syngeneic, Open Approach
- 0BYL0Z2 Transplantation of Left Lung, Zooplastic, Open Approach
- 0BYM0Z0 Transplantation of Bilateral Lungs, Allogeneic, Open Approach
- 0BYM0Z1 Transplantation of Bilateral Lungs, Syngeneic, Open Approach
- 0BYM0Z2 Transplantation of Bilateral Lungs, Zooplastic, Open Approach
Gastrointestinal System6 codes
- 0DY80Z0 Transplantation of Small Intestine, Allogeneic, Open Approach
- 0DY80Z1 Transplantation of Small Intestine, Syngeneic, Open Approach
- 0DY80Z2 Transplantation of Small Intestine, Zooplastic, Open Approach
- 0DYE0Z0 Transplantation of Large Intestine, Allogeneic, Open Approach
- 0DYE0Z1 Transplantation of Large Intestine, Syngeneic, Open Approach
- 0DYE0Z2 Transplantation of Large Intestine, Zooplastic, Open Approach
Hepatobiliary System and Pancreas5 codes
Urinary System6 codes
- 0TY00Z0 Transplantation of Right Kidney, Allogeneic, Open Approach
- 0TY00Z1 Transplantation of Right Kidney, Syngeneic, Open Approach
- 0TY00Z2 Transplantation of Right Kidney, Zooplastic, Open Approach
- 0TY10Z0 Transplantation of Left Kidney, Allogeneic, Open Approach
- 0TY10Z1 Transplantation of Left Kidney, Syngeneic, Open Approach
- 0TY10Z2 Transplantation of Left Kidney, Zooplastic, Open Approach
Questions About This Code Edit
What is the limited coverage Medicare code edit?
For certain procedures whose medical complexity and serious nature incur extraordinary associated costs, Medicare limits coverage to a portion of the cost. The Medicare Code Editor flags any inpatient claim that triggers the check.
How many codes are on the limited coverage list?
The FY 2026 list contains 49 codes, imported from the CMS Definitions of Medicare Code Edits v43.0.
What happens when a claim triggers this edit?
For these complex, high-cost procedures, mostly organ transplants and heart assist systems, Medicare limits coverage to a portion of the cost rather than denying or fully paying the claim.
Does this edit make the codes invalid?
No. Every code on this list is a valid code. The edit is about Medicare payment rules, not about whether the code exists or can be documented.
Other ICD-10-PCS Medicare Code Edits
Source: CMS Definitions of Medicare Code Edits v43.0, effective October 1, 2025 through September 30, 2026. Code lists are imported directly from the official manual. See also the ICD-10-CM diagnosis edits and the MS-DRG list.
