Is Z90.13 a billable ICD-10-CM code?

Yes. Z90.13 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Z90.13 sit in the tabular list?

Factors influencing health status and contact with health services (Z00-Z99), in the block Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).

Z90.13

Z90.13 — Acquired absence of bilateral breasts and nipples

Billable / specific codeICD-10-CMPOA exemptbilateral

Z90.13 is a billable, specific ICD-10-CM code for acquired absence of bilateral breasts and nipples. It is valid for submission on a claim.

Risk adjustment

Z90.13 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

Z90.13 is named in 4 Medicare coverage policies — 4 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52478External Breast Prostheses - Policy Article
A56658Billing and Coding: Cosmetic and Reconstructive Surgery
A58774Billing and Coding: Cosmetic and Reconstructive Surgery
A59299Billing and Coding: Cosmetic and Reconstructive Surgery

Related codes at this level

Codes that share Z90.1. If Z90.13 is not quite right, the correct code is usually one of these.

Questions about Z90.13

Is Z90.13 a billable ICD-10-CM code?: Yes. Z90.13 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Z90.13 sit in the tabular list?: Factors influencing health status and contact with health services (Z00-Z99), in the block Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).