Is T56.94XA a billable ICD-10-CM code?

Yes. T56.94XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does T56.94XA sit in the tabular list?

Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Toxic effects of substances chiefly nonmedicinal as to source (T51-T65).

What cannot be coded together with T56.94XA?

T56.94XA carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above T56.94XA (T56) and apply to it just the same.

T56.94XA

T56.94XA — Toxic effect of unspecified metal, undetermined, initial encounter

Billable / specific codeICD-10-CM

T56.94XA is a billable, specific ICD-10-CM code for toxic effect of unspecified metal, undetermined, initial encounter. It is valid for submission on a claim.

7th character "A" — initial encounter

The appropriate 7th character is to be added to each code from category T56

A: initial encounter
D: subsequent encounter
S: sequela

Excludes1 inherited from the categories above T56.94XA

These are not written on T56.94XA, but they bind it: a note on a category applies to every code beneath it. Billing T56.94XA with anything listed here is a denial.

Written on T56 — Toxic effect of metals

arsenic and its compounds (T57.0)
manganese and its compounds (T57.2)

Risk adjustment

T56.94XA does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

T56.94XA is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56612Billing and Coding: CT of the Head
A57205Billing and Coding: Oximetry Services

Code history

T56.94XA has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share T56.94. If T56.94XA is not quite right, the correct code is usually one of these.

Questions about T56.94XA

Is T56.94XA a billable ICD-10-CM code?: Yes. T56.94XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does T56.94XA sit in the tabular list?: Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Toxic effects of substances chiefly nonmedicinal as to source (T51-T65).
What cannot be coded together with T56.94XA?: T56.94XA carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above T56.94XA (T56) and apply to it just the same.