ICD-10 I42
Non-Billable HeaderCardiomyopathy
About ICD-10-CM I42
ICD-10-CM code I42 represents Cardiomyopathy. This is a non-billable header code in the Circulatory System chapter (block I42). The 2026 edition of ICD-10-CM I42 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 2 Excludes
Not included here, the excluded code is not part of I42, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- ischemic cardiomyopathy (I25.5)
- peripartum cardiomyopathy (O90.3)
- ventricular hypertrophy (I51.7)
Includes
- myocardiopathy
Coding Notes
Code First
- pre-existing cardiomyopathy complicating pregnancy and puerperium (O99.4)
Medicare LCD Coverage for I42
Local Coverage Determinations (LCDs) from CMS MACs that list I42 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 I42.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but I42 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with I42
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 I42
Other codes in section I30-I5A (Other forms of heart disease).
ICD-10 I42, Billing FAQ
Is ICD-10 code I42 billable? +
No, I42 is a non-billable header code. Use a more specific child code from block I42 when submitting claims.
What codes are Type 2 Excludes for I42? +
Type 2 Excludes (may be coded together when both conditions exist): ischemic cardiomyopathy (I25.5); peripartum cardiomyopathy (O90.3); ventricular hypertrophy (I51.7)
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team