ICD-10 K43
Non-Billable HeaderVentral hernia
About ICD-10-CM K43
ICD-10-CM code K43 represents Ventral hernia. This is a non-billable header code in the Digestive System chapter (block K43). The 2026 edition of ICD-10-CM K43 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.
Medicare LCD Coverage for K43
Local Coverage Determinations (LCDs) from CMS MACs that list K43 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 K43.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but K43 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with K43
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 K43
Other codes in section K40-K46 (Hernia).
ICD-10 K43, Billing FAQ
Is ICD-10 code K43 billable? +
No, K43 is a non-billable header code. Use a more specific child code from block K43 when submitting claims.
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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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