ICD-10 K03.81
Billable / SpecificCracked tooth
About ICD-10-CM K03.81
ICD-10-CM code K03.81 represents Cracked tooth. This is a billable/specific code in the Digestive System chapter (block K03). The 2026 edition of ICD-10-CM K03.81 became effective on October 1, 2025.
Type 1 Excludes
Pure excludes, these codes can never be coded together with K03.81. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- asymptomatic craze lines in enamel - omit code
- broken or fractured tooth due to trauma (S02.5)
Medicare LCD Coverage for K03.81
Local Coverage Determinations (LCDs) from CMS MACs that list K03.81 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 K03.81.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but K03.81 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with K03.81
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.
Convert K03.81 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 |
|---|---|---|
| K03.81 | 52181 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K03.81
Other codes in section K00-K14 (Diseases of oral cavity and salivary glands).
ICD-10 K03.81, Billing FAQ
Is ICD-10 code K03.81 billable? +
Yes, K03.81 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for K03.81? +
Type 1 Excludes (never code together with K03.81): asymptomatic craze lines in enamel - omit code; broken or fractured tooth due to trauma (S02.5)
What ICD-9 codes does K03.81 map to? +
Per CMS GEMs, K03.81 maps to ICD-9 codes: 52181. 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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