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

ICD-10 N42.30

Billable / Specific

Unspecified dysplasia of prostate

N42
Block
0
Synonyms
17
LCDs
4
Payer Policies
0
Linked CPTs

About ICD-10-CM N42.30

ICD-10-CM code N42.30 represents Unspecified dysplasia of prostate. This is a billable/specific code in the Genitourinary System chapter (block N42). The 2026 edition of ICD-10-CM N42.30 became effective on October 1, 2025.

Medicare LCD Coverage for N42.30

Local Coverage Determinations (LCDs) from CMS MACs that list N42.30 as a covered diagnosis.

17 LCDs

Showing top 10 of 17 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: Lab: Flow Cytometry
Article ID: 57689, Effective: 2025-11-06 00:00:00, 1518 covered, 0 non-covered
CPT 88189 →
CMS LCD: Billing and Coding: Lab: Flow Cytometry
Article ID: 57689, Effective: 2025-11-06 00:00:00, 1518 covered, 0 non-covered
CPT 86360 →
CMS LCD: Billing and Coding: Lab: Flow Cytometry
Article ID: 57689, Effective: 2025-11-06 00:00:00, 1518 covered, 0 non-covered
CPT 86361 →
CMS LCD: Billing and Coding: Lab: Flow Cytometry
Article ID: 57689, Effective: 2025-11-06 00:00:00, 1518 covered, 0 non-covered
CPT 88187 →
CMS LCD: Billing and Coding: Lab: Flow Cytometry
Article ID: 57689, Effective: 2025-11-06 00:00:00, 1518 covered, 0 non-covered
CPT 86363 →
CMS LCD: Billing and Coding: Lab: Flow Cytometry
Article ID: 57689, Effective: 2025-11-06 00:00:00, 1518 covered, 0 non-covered
CPT 86359 →
CMS LCD: Billing and Coding: Lab: Flow Cytometry
Article ID: 57689, Effective: 2025-11-06 00:00:00, 1518 covered, 0 non-covered
CPT 86356 →
CMS LCD: Billing and Coding: Lab: Flow Cytometry
Article ID: 57689, Effective: 2025-11-06 00:00:00, 1518 covered, 0 non-covered
CPT 88188 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing N42.30.

4 policies

2 Medicare

Billing and Coding: Transrectal Ultrasound
Policy ID: ART-57427
Billing and Coding: Lab: Flow Cytometry
Policy ID: ART-57689

2 Aetna

Prostate Cancer Screening
Policy ID: CPB-0521
Prostate Biopsy
Policy ID: CPB-0698

CPT Codes Commonly Billed with N42.30

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

No procedure linkages on file for N42.30

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 N42.30 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
N42.30 6023 10000

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

ICD-10 N42.30, Billing FAQ

Is ICD-10 code N42.30 billable? +

Yes, N42.30 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What ICD-9 codes does N42.30 map to? +

Per CMS GEMs, N42.30 maps to ICD-9 codes: 6023. 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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