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| Line | Diagnostic Category | ICD-10-CM Code | |
|---|---|---|---|
| Selected Infectious and Parasitic Diseases | |||
| 1–2 | Symptomatic/Asymptomatic human immunodeficiency virus (HIV) | B20, B97.35, O98.7-, Z21 | |
| 3 | Tuberculosis | A15- through A19-, O98.0 | |
| 4 | Sexually transmitted infections | A50- through A64- | |
| 4a | Hepatitis B | B16.0 through B16.2, B16.9, B17.0, B18.0, B18.1, B19.1-, O98.4- | |
| 4b | Hepatitis C | B17.1-, B18.2, B19.2- | |
| 4c | Novel coronavirus (SARS-CoV-2) disease | U07.1 | |
| Selected Diseases of the Respiratory System | |||
| 5 | Asthma | J45- | |
| 6 | Chronic lower respiratory diseases | J40 (count only when code U07.1 is not present), J41- through J44-, J47- | |
| 6a | Acute respiratory illness due to novel coronavirus (SARS-CoV-2) disease | J12.89, J20.8, J40, J22, J98.8, J80 (count only when code U07.1 is present) | |
| Selected Other Medical Conditions | |||
| 7 | Abnormal breast findings, female | C50.01-, C50.11-, C50.21-, C50.31-, C50.41-, C50.51-, C50.61-, C50.81-, C50.91-, C79.81, D05-, D48.6-, D49.3, N60-, N63-, R92- | |
| 8 | Abnormal cervical findings | C53-, C79.82, D06-, R87.61-, R87.629, R87.810, R87.820 | |
| 9 | Diabetes mellitus | E08- through E13-, O24- (exclude O24.41-) | |
| 10 | Heart disease (selected) | I01-, I02- (exclude I02.9), I20- through I25-, I27-, I28-, I30- through I52- | |
| 11 | Hypertension | I10- through I16-, O10-, O11- | |
| 12 | Contact dermatitis and other eczema | L23- through L25-, L30- (excludeL30.1, L30.3, L30.4, L30.5), L58- | |
| 13 | Dehydration | E86- | |
| 14 | Exposure to heat or cold | T33-, T34-, T67-, T68-, T69-, W92-, W93- | |
| 14a | Overweight and obesity | E66-, Z68- (exclude Z68.1, Z68.20 through Z68.24, Z68.51, Z68.52) | |
| Selected Childhood Conditions (limited to ages 0 through 17) | |||
| 15 | Otitis media and Eustachian tube disorders | H65- through H69- | |
| 16 | Selected perinatal/neonatal medical conditions | A33-, P19-, P22- through P29- (exclude P29.3), P35- through P96- (exclude P54-, P91.6-, P92-, P96.81), R78.81, R78.89 | |
| 17 | Lack of expected normal physiological development (such as delayed milestone, failure to gain weight, failure to thrive); nutritional deficiencies in children only. Does not include sexual or mental development. | E40- through E46-, E50- through E63-, P92-, R62- (exclude R62.7), R63.3 | |
| Selected Mental Health Conditions, Substance Use Disorders, and Exploitations | |||
| 18 | Alcohol-related disorders | F10-, G62.1, O99.31- | |
| 19 | Other substance-related disorders (excluding tobacco use disorders) | F11- through F19- (exclude F17-), G62.0, O99.32- | |
| 19a | Tobacco use disorder | F17-, O99.33- | |
| 20a | Depression and other mood disorders | F30- through F39- | |
| 20b | Anxiety disorders, including posttraumatic stress disorder (PTSD) | F06.4, F40- through F42-, F43.0, F43.1-, F93.0 | |
| 20c | Attention deficit and disruptive behavior disorders | F90- through F91- | |
| 20d | Other mental disorders, excluding drug or alcohol dependence | F01- through F09- (exclude F06.4), F20- through F29-, F43- through F48- (exclude F43.0- and F43.1-), F50- through F99- (exclude F55-, F84.2, F90-, F91-, F93.0, F98-), O99.34-, R45.1, R45.2, R45.5, R45.6, R45.7, R45.81, R45.82, R48.0 | |
| 20e | Human trafficking | T74.5- through T74.6-, T76.5- through T76.6-, Z04.81, Z04.82, Z62.813, Z91.42 | |
| 20f | Intimate partner violence | T74.11, T74.21, T74.31, Z69.11, Y07.0 | |
| Selected Diagnostic Tests/ Screening/Preventive Services | |||
| 21 | HIV test | CPT-4: 86689, 86701 through 86703, 87389 through 87391, 87534 through 87539, 87806 | |
| 21a | Hepatitis B test | CPT-4: 86704 through 86707, 87340, 87341, 87350 | |
| 21b | Hepatitis C test | CPT-4: 86803, 86804, 87520 through 87522 | |
| 21c | Novel coronavirus (SARS-CoV-2) diagnostic test | CPT-4: 87426, 87635 HCPCS: U0001, U0002, U0003, U0004 CPT PLA: 0202U, 0223U, 0225U | |
| 21d | Novel coronavirus (SARS-CoV-2) antibody test | CPT-4: 86328, 86408, 86409, 86769 CPT PLA: 0224U, 0226U | |
| 21e | Pre-Exposure Prophylaxis (PrEP)- associated management of all PrEP patients | CPT-4: 99401-99404 ICD-10: Z11.3, Z11.4, Z20.2, Z20.6, Z51.81, Z71.51, Z71.7, Z79.899 Limit to emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) or emtricitabine/tenofovir alafenamide (FTC/TAF) for PrEP | |
| 22 | Mammogram | CPT-4: 77065, 77066, 77067 ICD-10: Z12.31 | |
| 23 | Pap test | CPT-4: 88141 through 88153, 88155, 88164 through 88167, 88174, 88175 ICD-10: Z01.41-, Z01.42, Z12.4 (exclude Z01.411 and Z01.419) | |
| 24 | Selected immunizations: hepatitis A; haemophilus influenzae B (HiB); pneumococcal, diphtheria, tetanus, pertussis (DTaP) (DTP) (DT); measles, mumps, rubella (MMR); poliovirus; varicella; hepatitis B | CPT-4: 90632, 90633, 90634, 90636, 90643, 90644, 90645, 90646, 90647, 90648, 90669, 90670, 90696, 90697, 90698, 90700, 90701, 90702, 90703, 90704, 90705, 90706, 90707, 90708, 90710, 90712, 90713, 90714, 90715, 90716, 90718, 90720, 90721, 90723, 90730, 90731, 90732, 90740, 90743, 90744, 90745, 90746, 90747, 90748 | |
| 24a | Seasonal flu vaccine | CPT-4: 90630, 90653 through 90657, 90658, 90661, 90662, 90672, 90673, 90674, 90682, 90685 through 90689, 90756 | |
| 25 | Contraceptive management | ICD-10: Z30 | |
| 26 | Health supervision of infant or child (ages 0 through 11) | CPT-4: 99381 through 99383, 99391 through 99393 ICD-10: Z00.1- | |
| 26a | Childhood lead test screening (9 to 72 months) | ICD-10: Z13.88 CPT-4: 83655 | |
| 26b | Screening, Brief Intervention, and Referral to Treatment (SBIRT) | CPT-4: 99408, 99409 HCPCS: G0396, G0397, G0443, H0050 | |
| 26c | Smoke and tobacco use cessation counseling | CPT-4: 99406, 99407 HCPCS: S9075 CPT-II: 4000F, 4001F, 4004F | |
| 26d | Comprehensive and intermediate eye exams | CPT-4: 92002, 92004, 92012, 92014 | |
| Selected Dental Services | |||
| 27 | Emergency services | CDT: D0140, D9110 | |
| 28 | Oral exams | CDT: D0120, DO145, D0150, D0160, D0170, D0171, D0180 | |
| 29 | Prophylaxis—adult or child | CDT: D1110, D1120 | |
| 30 | Sealants | CDT: D1351 | |
| 31 | Fluoride treatment—adult or child | CDT: D1206, D1208 CPT-4: 99188 | |
| 32 | Restorative services | CDT: D21xx through D29xx | |
| 33 | Oral surgery (extractions and other surgical procedures) | CDT: D7xxx | |
| 34 | Rehabilitative services (Endo, Perio, Prostho, Ortho) | CDT: D3xxx, D4xxx, D5xxx, D6xxx, D8xxx |
UDS Table 6A Services Rendered:
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