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

ICD-10 Q12.3

Billable / Specific

Congenital aphakia

Q12
Block
0
Synonyms
62
LCDs
11
Payer Policies
0
Linked CPTs

About ICD-10-CM Q12.3

ICD-10-CM code Q12.3 represents Congenital aphakia. This is a billable/specific code in the Congenital Malformations chapter (block Q12). The 2026 edition of ICD-10-CM Q12.3 became effective on October 1, 2025.

Medicare LCD Coverage for Q12.3

Local Coverage Determinations (LCDs) from CMS MACs that list Q12.3 as a covered diagnosis.

62 LCDs

Showing top 10 of 62 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92524 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 96112 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92521 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97130 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97129 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92597 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97110 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97533 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 96110 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92522 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing Q12.3.

11 policies

3 Aetna

Corneal Remodeling - Medical Clinical Policy Bulletins | Aetna
Policy ID: CPB-0023
Contact Lenses and Eyeglasses
Policy ID: CPB-0126
Cataract Surgery
Policy ID: CPB-0508

5 Medicare

Refractive Lenses - Policy Article
Policy ID: ART-52499
Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Policy ID: ART-54111
Billing and Coding: Cataract Extraction
Policy ID: ART-56453
Billing and Coding: Cataract Extraction
Policy ID: ART-56544
Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation
Policy ID: ART-56549

CPT Codes Commonly Billed with Q12.3

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

No procedure linkages on file for Q12.3

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 Q12.3 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
Q12.3 74335 00000

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

ICD-10 Q12.3, Billing FAQ

Is ICD-10 code Q12.3 billable? +

Yes, Q12.3 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What ICD-9 codes does Q12.3 map to? +

Per CMS GEMs, Q12.3 maps to ICD-9 codes: 74335. 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 May 31, 2026.

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