ICD-10 H72
Non-Billable HeaderPerforation of tympanic membrane
About ICD-10-CM H72
ICD-10-CM code H72 represents Perforation of tympanic membrane. This is a non-billable header code in the Ear and Mastoid Process chapter (block H72). The 2026 edition of ICD-10-CM H72 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Type 1 Excludes
Pure excludes, these codes can never be coded together with H72. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- acute suppurative otitis media with rupture of the tympanic membrane (H66.01-)
- traumatic rupture of ear drum (S09.2-)
Includes
- persistent post-traumatic perforation of ear drum
- postinflammatory perforation of ear drum
Coding Notes
Code First
- any associated otitis media (H65.-, H66.1-, H66.2-, H66.3-, H66.4-, H66.9-, H67.-)
Medicare LCD Coverage for H72
Local Coverage Determinations (LCDs) from CMS MACs that list H72 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing H72.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but H72 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with H72
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To H72
Other codes in section H65-H75 (Diseases of middle ear and mastoid).
ICD-10 H72, Billing FAQ
Is ICD-10 code H72 billable? +
No, H72 is a non-billable header code. Use a more specific child code from block H72 when submitting claims.
What codes are Type 1 Excludes for H72? +
Type 1 Excludes (never code together with H72): acute suppurative otitis media with rupture of the tympanic membrane (H66.01-); traumatic rupture of ear drum (S09.2-)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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