Non-covered Procedure Codes Transplants ICD-10-PCS
The non-covered procedure codes transplants edit is a coverage check in Medicare’s claim-validation software, the Medicare Code Editor (MCE). It covers the 8 ICD-10-PCS procedure codes listed below. A pancreas transplant reported alone, without a kidney transplant code, is non-covered unless a qualifying type 1 diabetes diagnosis is also on the claim.
Diagnosis Condition
These transplant procedures are covered only when at least one of the following diagnoses is reported as the principal or a secondary diagnosis. Without one of them, the procedure is non-covered.
Procedure Codes in This Edit 8 codes · 2 categories
Hepatobiliary System and Pancreas2 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 non-covered procedure codes transplants Medicare code edit?
ICD-10-PCS procedure codes for pancreas transplants (0FYG0Z0, 0FYG0Z1) alone [without kidney transplant codes (0TY00Z0, 0TY00Z1, 0TY00Z2, 0TY10Z0, 0TY10Z1, 0TY10Z2)] are considered "Non-covered procedures" except for the following condition: When either 0FYG0Z0 (Transplantation of Pancreas, Allogeneic, Open Approach) or 0FYG0Z1 (Transplantation of Pancreas, Syngeneic, Open Approach) is combined with at least one principal or secondary diagnosis code from the following diagnoses list. The Medicare Code Editor flags any inpatient claim that triggers the check.
How many codes are on the non-covered procedure codes transplants list?
The FY 2027 list contains 8 codes, imported from the CMS Definitions of Medicare Code Edits v44.0.
When does the non-covered procedure codes transplants edit apply?
These transplant procedures are covered only when at least one of the following diagnoses is reported as the principal or a secondary diagnosis. Without one of them, the procedure is non-covered. The condition list contains 85 ICD-10-CM diagnosis codes.
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 v44.0, effective October 1, 2026 through September 30, 2027. Code lists are imported directly from the official manual. See also the ICD-10-CM diagnosis edits and the MS-DRG list.
