2026 ICD-10-CM Diagnosis Code N64.81Ptosis of breast
ICD-10-CM Codes›N00–N99›N60-N65›N64
- Billable — Valid for Submission
- Chronic Condition
N64.81 is a billable ICD-10-CM diagnosis code for ptosis of breast. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 600 through 601. The code is restricted by the Medicare Code Editor to adult patients (age 15 through 124). Coders also document this condition as bilateral ptotic breasts. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Nonmalignant breast conditions.
This medical diagnosis code is frequently used in OB/GYN medical specialties to designate conditions such lump in breast and other disorders of the breast.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for N64.81.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Bilateral ptotic breasts
- Ptosis of left breast
- Ptosis of right breast
- Ptotic breast
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Type 1 Excludes
- ptosis of native breast in relation to reconstructed breast N65.1
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
Index to Diseases and InjuriesGuidance
External Cause of Injuries IndexGuidance
References for this code in the External Cause of Injuries Index.
- Ptosis
- breast
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Breast Diseases
Breast diseases include various conditions and changes in your breast. Most women experience breast changes at some time. Your age, hormone levels, and medicines you take may cause lumps, bumps, and discharges of fluids that are not breast milk.
The full article covers:
- What are breast diseases?
- What are the symptoms of breast disease?
- How are breast diseases diagnosed?
- What are the treatments for breast disease?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert N64.81 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About N64.81Overview
Is N64.81 (Other specified disorders of breast) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report ptosis of breast on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does N64.81 group to?
When ptosis of breast is the principal diagnosis on an inpatient stay, it groups to MS-DRG 600, 601, with relative weights from 0.6050 to 1.0416 depending on complications. Higher weights mean higher Medicare reimbursement.
Who can N64.81 be reported for?
The Medicare Code Editor checks ptosis of breast against patient demographics: this code is intended for adult patients (age 15 through 124). Claims outside these limits are flagged as inconsistent.
What is the ICD-9 equivalent of N64.81?
Under the General Equivalence Mappings, ptosis of breast converts to ICD-9-CM 611.81 (ptosis of breast). The mapping is a direct match.
Footnotes
[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:
- The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
- The condition places limitations on self-care, independent living, and social interactions.
