Medicare Code Edits · FY 2026 MCE v43.0
Non-covered Procedure Codes ICD-10-PCS
The non-covered procedure codes edit is a coverage check in Medicare’s claim-validation software, the Medicare Code Editor (MCE). It covers the 95 ICD-10-PCS procedure codes listed below. When one of these codes is reported on an inpatient claim, the Medicare Code Editor flags it and the procedure is denied as non-covered, in any clinical circumstance.
✓ Built from the official CMS MCE v43.0 dataset Always non-covered, no exceptionsEffective Oct 1, 2025 – Sep 30, 2026
95
ICD-10-PCS Codes
13
Body Systems
$0
Medicare Reimbursement
ICD-10-PCS
Procedure Codes in This Edit 95 codes · 13 categories
95 of 95 shown
Central Nervous System and Cranial Nerves4 codes
Heart and Great Vessels9 codes
- 02BK0ZZ Excision of Right Ventricle, Open Approach
- 02BK3ZZ Excision of Right Ventricle, Percutaneous Approach
- 02BK4ZZ Excision of Right Ventricle, Percutaneous Endoscopic Approach
- 02BL0ZZ Excision of Left Ventricle, Open Approach
- 02BL3ZZ Excision of Left Ventricle, Percutaneous Approach
- 02BL4ZZ Excision of Left Ventricle, Percutaneous Endoscopic Approach
- 02FNXZZ Fragmentation in Pericardium, External Approach
- 02HA3QZ Insertion of Implantable Heart Assist System into Heart, Percutaneous Approach
- 02HA4QZ Insertion of Implantable Heart Assist System into Heart, Percutaneous Endoscopic Approach
Upper Arteries2 codes
Upper Veins2 codes
Eye10 codes
- 08F4XZZ Fragmentation in Right Vitreous, External Approach
- 08F5XZZ Fragmentation in Left Vitreous, External Approach
- 08Q8XZZ Repair Right Cornea, External Approach
- 08Q9XZZ Repair Left Cornea, External Approach
- 08U80KZ Supplement Right Cornea with Nonautologous Tissue Substitute, Open Approach
- 08U83KZ Supplement Right Cornea with Nonautologous Tissue Substitute, Percutaneous Approach
- 08U8XKZ Supplement Right Cornea with Nonautologous Tissue Substitute, External Approach
- 08U90KZ Supplement Left Cornea with Nonautologous Tissue Substitute, Open Approach
- 08U93KZ Supplement Left Cornea with Nonautologous Tissue Substitute, Percutaneous Approach
- 08U9XKZ Supplement Left Cornea with Nonautologous Tissue Substitute, External Approach
Respiratory System10 codes
- 0BF1XZZ Fragmentation in Trachea, External Approach
- 0BF2XZZ Fragmentation in Carina, External Approach
- 0BF3XZZ Fragmentation in Right Main Bronchus, External Approach
- 0BF4XZZ Fragmentation in Right Upper Lobe Bronchus, External Approach
- 0BF5XZZ Fragmentation in Right Middle Lobe Bronchus, External Approach
- 0BF6XZZ Fragmentation in Right Lower Lobe Bronchus, External Approach
- 0BF7XZZ Fragmentation in Left Main Bronchus, External Approach
- 0BF8XZZ Fragmentation in Left Upper Lobe Bronchus, External Approach
- 0BF9XZZ Fragmentation in Lingula Bronchus, External Approach
- 0BFBXZZ Fragmentation in Left Lower Lobe Bronchus, External Approach
Mouth and Throat2 codes
Gastrointestinal System19 codes
- 0DF5XZZ Fragmentation in Esophagus, External Approach
- 0DF6XZZ Fragmentation in Stomach, External Approach
- 0DF8XZZ Fragmentation in Small Intestine, External Approach
- 0DF9XZZ Fragmentation in Duodenum, External Approach
- 0DFAXZZ Fragmentation in Jejunum, External Approach
- 0DFBXZZ Fragmentation in Ileum, External Approach
- 0DFEXZZ Fragmentation in Large Intestine, External Approach
- 0DFFXZZ Fragmentation in Right Large Intestine, External Approach
- 0DFGXZZ Fragmentation in Left Large Intestine, External Approach
- 0DFHXZZ Fragmentation in Cecum, External Approach
- 0DFJXZZ Fragmentation in Appendix, External Approach
- 0DFKXZZ Fragmentation in Ascending Colon, External Approach
- 0DFLXZZ Fragmentation in Transverse Colon, External Approach
- 0DFMXZZ Fragmentation in Descending Colon, External Approach
- 0DFNXZZ Fragmentation in Sigmoid Colon, External Approach
- 0DFPXZZ Fragmentation in Rectum, External Approach
- 0DFQXZZ Fragmentation in Anus, External Approach
- 0DV67DZ Restriction of Stomach with Intraluminal Device, Via Natural or Artificial Opening
- 0DV68DZ Restriction of Stomach with Intraluminal Device, Via Natural or Artificial Opening Endoscopic
Hepatobiliary System and Pancreas9 codes
- 0FF4XZZ Fragmentation in Gallbladder, External Approach
- 0FF5XZZ Fragmentation in Right Hepatic Duct, External Approach
- 0FF6XZZ Fragmentation in Left Hepatic Duct, External Approach
- 0FF8XZZ Fragmentation in Cystic Duct, External Approach
- 0FF9XZZ Fragmentation in Common Bile Duct, External Approach
- 0FFCXZZ Fragmentation in Ampulla of Vater, External Approach
- 0FFDXZZ Fragmentation in Pancreatic Duct, External Approach
- 0FFFXZZ Fragmentation in Accessory Pancreatic Duct, External Approach
- 0FYG0Z2 Transplantation of Pancreas, Zooplastic, Open Approach
Subcutaneous Tissue and Fascia4 codes
- 0JH70MZ Insertion of Stimulator Generator into Back Subcutaneous Tissue and Fascia, Open Approach
- 0JH73MZ Insertion of Stimulator Generator into Back Subcutaneous Tissue and Fascia, Percutaneous Approach
- 0JH80MZ Insertion of Stimulator Generator into Abdomen Subcutaneous Tissue and Fascia, Open Approach
- 0JH83MZ Insertion of Stimulator Generator into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach
Urinary System11 codes
- 0TFDXZZ Fragmentation in Urethra, External Approach
- 0THB0MZ Insertion of Stimulator Lead into Bladder, Open Approach
- 0THB3MZ Insertion of Stimulator Lead into Bladder, Percutaneous Approach
- 0THB4MZ Insertion of Stimulator Lead into Bladder, Percutaneous Endoscopic Approach
- 0THB7MZ Insertion of Stimulator Lead into Bladder, Via Natural or Artificial Opening
- 0THB8MZ Insertion of Stimulator Lead into Bladder, Via Natural or Artificial Opening Endoscopic
- 0TPB0MZ Removal of Stimulator Lead from Bladder, Open Approach
- 0TPB3MZ Removal of Stimulator Lead from Bladder, Percutaneous Approach
- 0TPB4MZ Removal of Stimulator Lead from Bladder, Percutaneous Endoscopic Approach
- 0TPB7MZ Removal of Stimulator Lead from Bladder, Via Natural or Artificial Opening
- 0TPB8MZ Removal of Stimulator Lead from Bladder, Via Natural or Artificial Opening Endoscopic
Female Reproductive System4 codes
Anatomical Regions, General9 codes
- 0WF1XZZ Fragmentation in Cranial Cavity, External Approach
- 0WF3XZZ Fragmentation in Oral Cavity and Throat, External Approach
- 0WF9XZZ Fragmentation in Right Pleural Cavity, External Approach
- 0WFBXZZ Fragmentation in Left Pleural Cavity, External Approach
- 0WFCXZZ Fragmentation in Mediastinum, External Approach
- 0WFGXZZ Fragmentation in Peritoneal Cavity, External Approach
- 0WFJXZZ Fragmentation in Pelvic Cavity, External Approach
- 0WFPXZZ Fragmentation in Gastrointestinal Tract, External Approach
- 0WFQXZZ Fragmentation in Respiratory Tract, External Approach
Questions About This Code Edit
What is the non-covered procedure codes Medicare code edit?
The procedures codes identified here are always non-covered procedures. The Medicare Code Editor flags any inpatient claim that triggers the check.
How many codes are on the non-covered procedure codes list?
The FY 2026 list contains 95 codes, imported from the CMS Definitions of Medicare Code Edits v43.0.
What happens when a claim triggers this edit?
When one of these codes is reported on an inpatient claim, the Medicare Code Editor flags it and the procedure is denied as non-covered, in any clinical circumstance.
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
Non-covered: TransplantsNon-covered: TransfuseNon-covered: Over Age 60Non-covered: SterilizationLimited CoverageWrong Procedure PerformedProcedure Inconsistent with LOSQuestionable Obstetric Admission
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.
