ICD-10 J94
Non-Billable HeaderOther pleural conditions
About ICD-10-CM J94
ICD-10-CM code J94 represents Other pleural conditions. This is a non-billable header code in the Respiratory System chapter (block J94). The 2026 edition of ICD-10-CM J94 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 J94. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- pleurisy NOS (R09.1)
- traumatic hemopneumothorax (S27.2)
- traumatic hemothorax (S27.1)
- tuberculous pleural conditions (current disease) (A15.-)
Medicare LCD Coverage for J94
Local Coverage Determinations (LCDs) from CMS MACs that list J94 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 J94.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but J94 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with J94
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 J94
Other codes in section J90-J94 (Other diseases of the pleura).
ICD-10 J94, Billing FAQ
Is ICD-10 code J94 billable? +
No, J94 is a non-billable header code. Use a more specific child code from block J94 when submitting claims.
What codes are Type 1 Excludes for J94? +
Type 1 Excludes (never code together with J94): pleurisy NOS (R09.1); traumatic hemopneumothorax (S27.2); traumatic hemothorax (S27.1)
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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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