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

ICD-10 N40.3

Billable / Specific

Nodular prostate with lower urinary tract symptoms

N40
Block
0
Synonyms
119
LCDs
12
Payer Policies
2
Linked CPTs

About ICD-10-CM N40.3

ICD-10-CM code N40.3 represents Nodular prostate with lower urinary tract symptoms. This is a billable/specific code in the Genitourinary System chapter (block N40). The 2026 edition of ICD-10-CM N40.3 became effective on October 1, 2025.

Use Additional Code

When coding N40.3, also report these additional codes when applicable.

  • code for associated symptoms, when specified:
  • incomplete bladder emptying (R39.14)
  • nocturia (R35.1)
  • straining on urination (R39.16)
  • urinary frequency (R35.0)
  • urinary hesitancy (R39.11)
  • urinary incontinence (N39.4-)
  • urinary obstruction (N13.8)
  • urinary retention (R33.8)
  • urinary urgency (R39.15)
  • weak urinary stream (R39.12)

Medicare LCD Coverage for N40.3

Local Coverage Determinations (LCDs) from CMS MACs that list N40.3 as a covered diagnosis.

119 LCDs

Showing top 10 of 119 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 N40.3.

12 policies

2 Aetna

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

5 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: Laser Ablation of the Prostate
Policy ID: ART-56467
Billing and Coding: Urodynamics
Policy ID: ART-56802
Billing and Coding: Transrectal Ultrasound
Policy ID: ART-57427

CPT Codes Commonly Billed with N40.3

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

2 linkages
  • 52649 CMS LCD: Billing and Coding: Laser Ablation of the Prostate CMS LCD
  • 52648 CMS LCD: Billing and Coding: Laser Ablation of the Prostate CMS LCD

Convert N40.3 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
N40.3 60011 10000

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

ICD-10 N40.3, Billing FAQ

Is ICD-10 code N40.3 billable? +

Yes, N40.3 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What CPT codes are commonly billed with N40.3? +

Procedures frequently paired with N40.3 include: 52649, 52648.

What ICD-9 codes does N40.3 map to? +

Per CMS GEMs, N40.3 maps to ICD-9 codes: 60011. Useful for legacy data review and historical claim analysis.

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.

Thanks!

If you want a code reference page that doesn't exist yet, email coding@payerready.com.

Sorry to hear that.

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 May 31, 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

Faster Approvals

Ready to Cut Your Enrollment Timeline in Half?

Join providers in all 50 states who handed off credentialing to a dedicated specialist. Create your free account in minutes and start enrolling the same day.

All 50 States Covered
No Long-Term Contracts
HIPAA HIPAA Compliant Platform
Dedicated Specialist Included