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

ICD-10 Q40.1

Billable / Specific

Congenital hiatus hernia

Q40
Block
1
Synonyms
154
LCDs
5
Payer Policies
0
Linked CPTs

About ICD-10-CM Q40.1

ICD-10-CM code Q40.1 represents Congenital hiatus hernia. This is a billable/specific code in the Congenital Malformations chapter (block Q40). The 2026 edition of ICD-10-CM Q40.1 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under Q40.1. Per CMS ICD-10-CM Tabular 2026.

  • Congenital displacement of cardia through esophageal hiatus

Type 1 Excludes

Pure excludes, these codes can never be coded together with Q40.1. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • congenital diaphragmatic hernia (Q79.0)

Medicare LCD Coverage for Q40.1

Local Coverage Determinations (LCDs) from CMS MACs that list Q40.1 as a covered diagnosis.

154 LCDs

Showing top 10 of 154 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43246 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43243 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43235 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43250 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43236 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43247 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43249 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43254 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43245 →
CMS LCD: Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article ID: 57063, Effective: 2025-10-01 00:00:00, 820 covered, 1 non-covered
CPT 43244 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing Q40.1.

5 policies

1 Cigna

Transthoracic Echocardiography in Children - (0523)
Policy ID: MM_0523

4 Medicare

Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
Policy ID: ART-56389
Billing and Coding: Transthoracic Echocardiography (TTE)
Policy ID: ART-56781
Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Policy ID: ART-57063
Billing and Coding: Transthoracic Echocardiography (TTE)
Policy ID: ART-57306

CPT Codes Commonly Billed with Q40.1

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

No procedure linkages on file for Q40.1

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 Q40.1 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
Q40.1 7506 00000

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

ICD-10 Q40.1, Billing FAQ

Is ICD-10 code Q40.1 billable? +

Yes, Q40.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to Q40.1? +

ICD-10 Q40.1 includes: Congenital displacement of cardia through esophageal hiatus.

What codes are Type 1 Excludes for Q40.1? +

Type 1 Excludes (never code together with Q40.1): congenital diaphragmatic hernia (Q79.0)

What ICD-9 codes does Q40.1 map to? +

Per CMS GEMs, Q40.1 maps to ICD-9 codes: 7506. 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 June 1, 2026.

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