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

ICD-10 R31.1

Billable / Specific

Benign essential microscopic hematuria

R31
Block
0
Synonyms
141
LCDs
11
Payer Policies
6
Linked CPTs

About ICD-10-CM R31.1

ICD-10-CM code R31.1 represents Benign essential microscopic hematuria. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R31). The 2026 edition of ICD-10-CM R31.1 became effective on October 1, 2025.

Medicare LCD Coverage for R31.1

Local Coverage Determinations (LCDs) from CMS MACs that list R31.1 as a covered diagnosis.

141 LCDs

Showing top 10 of 141 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74170 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74177 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74160 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74178 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74150 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72194 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74176 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72192 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72193 →
CMS LCD: Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography
Article ID: 56682, Effective: 2025-08-19 00:00:00, 250 covered, 1 non-covered
CPT 36253 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing R31.1.

11 policies

1 Cigna

Transvaginal Ultrasound, Non-Obstetrical - (0398)
Policy ID: MM_0398

5 Medicare

Billing and Coding: Biomarkers for Oncology
Policy ID: ART-52986
Billing and Coding: Lab: Bladder/Urothelial Tumor Markers
Policy ID: ART-53095
Billing and Coding: Lab: Bladder/Urothelial Tumor Markers
Policy ID: ART-55028
Billing and Coding: Retroperitoneal Ultrasound
Policy ID: ART-55336
Billing and Coding: CT of the Abdomen and Pelvis
Policy ID: ART-56421

CPT Codes Commonly Billed with R31.1

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

6 linkages
  • 88120 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
  • 86386 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
  • 86294 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
  • 86316 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
  • 88121 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
  • 82610 CMS LCD: Billing and Coding: Lab: Cystatin C Measurement CMS LCD

Convert R31.1 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
R31.1 59972 10000

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

ICD-10 R31.1, Billing FAQ

Is ICD-10 code R31.1 billable? +

Yes, R31.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What CPT codes are commonly billed with R31.1? +

Procedures frequently paired with R31.1 include: 88120, 86386, 86294, 86316, 88121.

What ICD-9 codes does R31.1 map to? +

Per CMS GEMs, R31.1 maps to ICD-9 codes: 59972. 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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