ICD-10 O42
Non-Billable HeaderPremature rupture of membranes
About ICD-10-CM O42
ICD-10-CM code O42 represents Premature rupture of membranes. This is a non-billable header code in the Pregnancy, Childbirth, and Puerperium chapter (block O42). The 2026 edition of ICD-10-CM O42 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.
Coding Tips for O42
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Most O codes require a 7th character indicating trimester (1 = first, 2 = second, 3 = third). Some require fetus identification character. Code O09 (supervision of high-risk pregnancy) is required as a secondary code when applicable.
Medicare LCD Coverage for O42
Local Coverage Determinations (LCDs) from CMS MACs that list O42 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 O42.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but O42 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with O42
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 O42
Other codes in section O30-O48 (Maternal care related to the fetus and amniotic cavity and possible delivery problems).
ICD-10 O42, Billing FAQ
Is ICD-10 code O42 billable? +
No, O42 is a non-billable header code. Use a more specific child code from block O42 when submitting claims.
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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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