ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 N40.0

Billable / Specific

Benign prostatic hyperplasia without lower urinary tract symptoms

N40
Block
2
Synonyms
78
LCDs
5
Payer Policies
3
Linked CPTs

About ICD-10-CM N40.0

ICD-10-CM code N40.0 represents Benign prostatic hyperplasia without lower urinary tract symptoms. This is a billable/specific code in the Genitourinary System chapter (block N40). The 2026 edition of ICD-10-CM N40.0 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under N40.0. Per CMS ICD-10-CM Tabular 2026.

  • Enlarged prostate without LUTS
  • Enlarged prostate NOS

Medicare LCD Coverage for N40.0

Local Coverage Determinations (LCDs) from CMS MACs that list N40.0 as a covered diagnosis.

78 LCDs

Showing top 10 of 78 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Transrectal Ultrasound
Article ID: 57427, Effective: 2024-10-01 00:00:00, 118 covered, 0 non-covered
CPT 76872 →
CMS LCD: Billing and Coding: Transrectal Ultrasound
Article ID: 57427, Effective: 2024-10-01 00:00:00, 118 covered, 0 non-covered
CPT 76873 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74170 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74177 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74160 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74178 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74150 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72194 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74176 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72192 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing N40.0.

5 policies

2 Aetna

Benign Prostatic Hyperplasia - Medical Clinical Policy Bulletins | Aetna
Policy ID: CPB-0079
Prostate Cancer Screening
Policy ID: CPB-0521

3 Medicare

Billing and Coding: Biomarkers for Oncology
Policy ID: ART-52986
Billing and Coding: CT of the Abdomen and Pelvis
Policy ID: ART-56421
Billing and Coding: Transrectal Ultrasound
Policy ID: ART-57427

CPT Codes Commonly Billed with N40.0

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

3 linkages
  • 55700 Prostate biopsy — elevated PSA, BPH, prostate cancer Urology
  • 52000 Cystoscopy diagnostic — bladder neck obstruction, cystitis, hematuria, hydronephrosis, bladder cancer, BPH, urinary retention, urethral stricture, poor stream, bladder calculus Urology
  • 52601 TURP — BPH with LUTS, BPH, urinary retention, poor stream, hydronephrosis, bladder neck obstruction, hematuria Urology

Convert N40.0 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
N40.0 60000 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 N40.0, Billing FAQ

Is ICD-10 code N40.0 billable? +

Yes, N40.0 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 N40.0? +

ICD-10 N40.0 includes: Enlarged prostate without LUTS; Enlarged prostate NOS.

What CPT codes are commonly billed with N40.0? +

Procedures frequently paired with N40.0 include: 55700, 52000, 52601.

What ICD-9 codes does N40.0 map to? +

Per CMS GEMs, N40.0 maps to ICD-9 codes: 60000. 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 June 1, 2026.

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