Medicare Code Edits · FY 2026 MCE v43.0
Procedures for Females Only ICD-10-PCS
Deactivated by CMS as of October 1, 2024
This edit checked inpatient claims for consistency between the patient's recorded sex and procedures applicable only to female patients. CMS deactivated the sex conflict edit (MCE edit 5) as of October 1, 2024, so these checks are no longer enforced during Medicare claims processing and the manual no longer publishes a code list.
Active Medicare Code Edits
Non-covered ProceduresNon-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. This page is kept for reference; the edit is no longer part of Medicare claims processing.
