ICD-10 Q64.0
Billable / SpecificEpispadias
About ICD-10-CM Q64.0
ICD-10-CM code Q64.0 represents Epispadias. This is a billable/specific code in the Congenital Malformations chapter (block Q64). The 2026 edition of ICD-10-CM Q64.0 became effective on October 1, 2025.
Type 1 Excludes
Pure excludes, these codes can never be coded together with Q64.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- hypospadias (Q54.-)
Medicare LCD Coverage for Q64.0
Local Coverage Determinations (LCDs) from CMS MACs that list Q64.0 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 Q64.0.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but Q64.0 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with Q64.0
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.
Convert Q64.0 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| Q64.0 | 75262 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To Q64.0
Other codes in section Q60-Q64 (Congenital malformations of the urinary system).
ICD-10 Q64.0, Billing FAQ
Is ICD-10 code Q64.0 billable? +
Yes, Q64.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for Q64.0? +
Type 1 Excludes (never code together with Q64.0): hypospadias (Q54.-)
What ICD-9 codes does Q64.0 map to? +
Per CMS GEMs, Q64.0 maps to ICD-9 codes: 75262. 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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