ICD-10 P04.16
Billable / SpecificNewborn affected by maternal use of amphetamines
About ICD-10-CM P04.16
ICD-10-CM code P04.16 represents Newborn affected by maternal use of amphetamines. This is a billable/specific code in the Perinatal Period chapter (block P04). The 2026 edition of ICD-10-CM P04.16 became effective on October 1, 2025.
Medicare LCD Coverage for P04.16
Local Coverage Determinations (LCDs) from CMS MACs that list P04.16 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 P04.16.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but P04.16 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with P04.16
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 P04.16
Other codes in section P00-P04 (Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery).
ICD-10 P04.16, Billing FAQ
Is ICD-10 code P04.16 billable? +
Yes, P04.16 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team