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

ICD-10 R07.0

Billable / Specific

Pain in throat

R07
Block
0
Synonyms
47
LCDs
4
Payer Policies
0
Linked CPTs

About ICD-10-CM R07.0

ICD-10-CM code R07.0 represents Pain in throat. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R07). The 2026 edition of ICD-10-CM R07.0 became effective on October 1, 2025.

Type 1 Excludes

Pure excludes, these codes can never be coded together with R07.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • chronic sore throat (J31.2)
  • sore throat (acute) NOS (J02.9)

Type 2 Excludes

Not included here, the excluded code is not part of R07.0, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.

  • dysphagia (R13.1-)
  • pain in neck (M54.2)

Medicare LCD Coverage for R07.0

Local Coverage Determinations (LCDs) from CMS MACs that list R07.0 as a covered diagnosis.

47 LCDs

Showing top 10 of 47 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Outpatient Psychiatry and Psychology Services
Article ID: 57065, Effective: 2025-11-06 00:00:00, 772 covered, 0 non-covered
CPT 90899 →
CMS LCD: Billing and Coding: Outpatient Psychiatry and Psychology Services
Article ID: 57065, Effective: 2025-11-06 00:00:00, 772 covered, 0 non-covered
CPT 96112 →
CMS LCD: Billing and Coding: Outpatient Psychiatry and Psychology Services
Article ID: 57065, Effective: 2025-11-06 00:00:00, 772 covered, 0 non-covered
CPT 96131 →
CMS LCD: Billing and Coding: Outpatient Psychiatry and Psychology Services
Article ID: 57065, Effective: 2025-11-06 00:00:00, 772 covered, 0 non-covered
CPT 96146 →
CMS LCD: Billing and Coding: Outpatient Psychiatry and Psychology Services
Article ID: 57065, Effective: 2025-11-06 00:00:00, 772 covered, 0 non-covered
CPT 96136 →
CMS LCD: Billing and Coding: Outpatient Psychiatry and Psychology Services
Article ID: 57065, Effective: 2025-11-06 00:00:00, 772 covered, 0 non-covered
CPT 90839 →
CMS LCD: Billing and Coding: Outpatient Psychiatry and Psychology Services
Article ID: 57065, Effective: 2025-11-06 00:00:00, 772 covered, 0 non-covered
CPT 90870 →
CMS LCD: Billing and Coding: Outpatient Psychiatry and Psychology Services
Article ID: 57065, Effective: 2025-11-06 00:00:00, 772 covered, 0 non-covered
CPT 90865 →
CMS LCD: Billing and Coding: Outpatient Psychiatry and Psychology Services
Article ID: 57065, Effective: 2025-11-06 00:00:00, 772 covered, 0 non-covered
CPT 90837 →
CMS LCD: Billing and Coding: Outpatient Psychiatry and Psychology Services
Article ID: 57065, Effective: 2025-11-06 00:00:00, 772 covered, 0 non-covered
CPT 90845 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing R07.0.

4 policies

3 Medicare

Billing and Coding: Magnetic Resonance Imaging of the Head and Neck
Policy ID: ART-56729
Billing and Coding: Outpatient Psychiatry and Psychology Services
Policy ID: ART-57065
Billing and Coding: Electrocardiograms
Policy ID: ART-57326

1 Aetna

Eagle's and Ernest Syndrome
Policy ID: CPB-0400

CPT Codes Commonly Billed with R07.0

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

No procedure linkages on file for R07.0

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 R07.0 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
R07.0 7841 00000

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

ICD-10 R07.0, Billing FAQ

Is ICD-10 code R07.0 billable? +

Yes, R07.0 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 R07.0? +

Type 1 Excludes (never code together with R07.0): chronic sore throat (J31.2); sore throat (acute) NOS (J02.9)

What codes are Type 2 Excludes for R07.0? +

Type 2 Excludes (may be coded together when both conditions exist): dysphagia (R13.1-); pain in neck (M54.2)

What ICD-9 codes does R07.0 map to? +

Per CMS GEMs, R07.0 maps to ICD-9 codes: 7841. 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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