L12.1

L12.1: Cicatricial pemphigoid

Billable / specific codeICD-10-CM

L12.1 is a billable, specific ICD-10-CM code for cicatricial pemphigoid. It is valid for submission on a claim.

Check L12.1 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Benign mucous membrane pemphigoid

Excludes1 inherited from the categories above L12.1

A category’s note binds every code beneath it.

Written on L12: Pemphigoid

herpes gestationis (O26.4-)
impetigo herpetiformis (L40.1)

Risk adjustment

L12.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 387 Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders0.406 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

L12.1 is named in 11 Medicare coverage policies: 11 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A54641Billing and Coding: Intravenous Immune Globulin (IVIg)-NCD 250.3
A54643Billing and Coding: Intravenous Immune Globulin (IVIg)-NCD 250.3
A55639Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions
A56380Billing and Coding: Rituximab

Alphabetic index entries that lead here

Pemphigoid›benign, mucous membrane
Pemphigoid›cicatricial
Pemphigoid›ocular
Pemphigus›conjunctiva
Pemphigus›ocular
Dermatitis›bullous, bullosa›mucosynechial, atrophic

Code history

Unchanged in every release from FY2024 to FY2027.