ICD-10 N64.5
Non-Billable HeaderOther signs and symptoms in breast
About ICD-10-CM N64.5
ICD-10-CM code N64.5 represents Other signs and symptoms in breast. This is a non-billable header code in the Genitourinary System chapter (block N64). The 2026 edition of ICD-10-CM N64.5 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Type 2 Excludes
Not included here, the excluded code is not part of N64.5, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- abnormal findings on diagnostic imaging of breast (R92.-)
Medicare LCD Coverage for N64.5
Local Coverage Determinations (LCDs) from CMS MACs that list N64.5 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 N64.5.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but N64.5 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with N64.5
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
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.
Codes Adjacent To N64.5
Other codes in section N60-N65 (Disorders of breast).
ICD-10 N64.5, Billing FAQ
Is ICD-10 code N64.5 billable? +
No, N64.5 is a non-billable header code. Use a more specific child code from block N64 when submitting claims.
What codes are Type 2 Excludes for N64.5? +
Type 2 Excludes (may be coded together when both conditions exist): abnormal findings on diagnostic imaging of breast (R92.-)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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