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

ICD-10 N64.4

Billable / Specific

Mastodynia

N64
Block
0
Synonyms
232
LCDs
11
Payer Policies
0
Linked CPTs

About ICD-10-CM N64.4

ICD-10-CM code N64.4 represents Mastodynia. This is a billable/specific code in the Genitourinary System chapter (block N64). The 2026 edition of ICD-10-CM N64.4 became effective on October 1, 2025.

Medicare LCD Coverage for N64.4

Local Coverage Determinations (LCDs) from CMS MACs that list N64.4 as a covered diagnosis.

232 LCDs

Showing top 10 of 232 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 19300 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 15877 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 19371 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 19380 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 30468 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 30400 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 19396 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 30435 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 30465 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 30462 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing N64.4.

11 policies

1 Cigna

Transvaginal Ultrasound, Non-Obstetrical - (0398)
Policy ID: MM_0398

5 Medicare

Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
Policy ID: ART-52849
Billing and Coding: Outpatient Physical Therapy
Policy ID: ART-53065
Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
Policy ID: ART-56448
Billing and Coding: Computerized Axial Tomography (CT), Thorax
Policy ID: ART-56580
Billing and Coding: Cosmetic and Reconstructive Surgery
Policy ID: ART-56587

1 Aetna

Breast Implant Removal
Policy ID: CPB-0142

CPT Codes Commonly Billed with N64.4

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

No procedure linkages on file for N64.4

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 N64.4 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
N64.4 61171 00000

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

ICD-10 N64.4, Billing FAQ

Is ICD-10 code N64.4 billable? +

Yes, N64.4 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What ICD-9 codes does N64.4 map to? +

Per CMS GEMs, N64.4 maps to ICD-9 codes: 61171. 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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