ICD-10 I05.1
Billable / SpecificRheumatic mitral insufficiency
About ICD-10-CM I05.1
ICD-10-CM code I05.1 represents Rheumatic mitral insufficiency. This is a billable/specific code in the Circulatory System chapter (block I05). The 2026 edition of ICD-10-CM I05.1 became effective on October 1, 2025.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under I05.1. Per CMS ICD-10-CM Tabular 2026.
- Rheumatic mitral incompetence
- Rheumatic mitral regurgitation
Type 1 Excludes
Pure excludes, these codes can never be coded together with I05.1. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- mitral insufficiency not specified as rheumatic (I34.0)
Medicare LCD Coverage for I05.1
Local Coverage Determinations (LCDs) from CMS MACs that list I05.1 as a covered diagnosis.
Showing top 10 of 398 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I05.1.
5 Medicare
CPT Codes Commonly Billed with I05.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 78431 CMS LCD: Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing CMS LCD
- 78492 CMS LCD: Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing CMS LCD
- 75563 CMS LCD: Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing CMS LCD
- 75559 CMS LCD: Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing CMS LCD
- 0742T CMS LCD: Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing CMS LCD
- 78434 CMS LCD: Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing CMS LCD
- 78430 CMS LCD: Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing CMS LCD
- 78491 CMS LCD: Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing CMS LCD
Convert I05.1 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| I05.1 | 3941 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I05.1
Other codes in section I05-I09 (Chronic rheumatic heart diseases).
ICD-10 I05.1, Billing FAQ
Is ICD-10 code I05.1 billable? +
Yes, I05.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to I05.1? +
ICD-10 I05.1 includes: Rheumatic mitral incompetence; Rheumatic mitral regurgitation.
What codes are Type 1 Excludes for I05.1? +
Type 1 Excludes (never code together with I05.1): mitral insufficiency not specified as rheumatic (I34.0)
What CPT codes are commonly billed with I05.1? +
Procedures frequently paired with I05.1 include: 78431, 78492, 75563, 75559, 0742T.
What ICD-9 codes does I05.1 map to? +
Per CMS GEMs, I05.1 maps to ICD-9 codes: 3941. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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