ICD-10 N42.9
Billable / SpecificDisorder of prostate, unspecified
About ICD-10-CM N42.9
ICD-10-CM code N42.9 represents Disorder of prostate, unspecified. This is a billable/specific code in the Genitourinary System chapter (block N42). The 2026 edition of ICD-10-CM N42.9 became effective on October 1, 2025.
Medicare LCD Coverage for N42.9
Local Coverage Determinations (LCDs) from CMS MACs that list N42.9 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 N42.9.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but N42.9 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with N42.9
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 55700 Prostate biopsy — elevated PSA, prostate disorder, prostate cancer, family hx prostate cancer, urinary retention, prostate screening Urology
Convert N42.9 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 |
|---|---|---|
| N42.9 | 6029 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To N42.9
Other codes in section N40-N53 (Diseases of male genital organs).
ICD-10 N42.9, Billing FAQ
Is ICD-10 code N42.9 billable? +
Yes, N42.9 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 N42.9? +
Procedures frequently paired with N42.9 include: 55700.
What ICD-9 codes does N42.9 map to? +
Per CMS GEMs, N42.9 maps to ICD-9 codes: 6029. 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 July 16, 2026.
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