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

ICD-10 R91.1

Billable / Specific

Solitary pulmonary nodule

R91
Block
2
Synonyms
58
LCDs
13
Payer Policies
4
Linked CPTs

About ICD-10-CM R91.1

ICD-10-CM code R91.1 represents Solitary pulmonary nodule. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R91). The 2026 edition of ICD-10-CM R91.1 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under R91.1. Per CMS ICD-10-CM Tabular 2026.

  • Coin lesion lung
  • Solitary pulmonary nodule, subsegmental branch of the bronchial tree

Medicare LCD Coverage for R91.1

Local Coverage Determinations (LCDs) from CMS MACs that list R91.1 as a covered diagnosis.

58 LCDs

Showing top 10 of 58 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94660 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94726 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94664 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94618 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94772 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94642 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT G0238 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94004 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94668 →
CMS LCD: Billing and Coding: Respiratory Care
Article ID: 57224, Effective: 2026-01-01 00:00:00, 901 covered, 0 non-covered
CPT 94680 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing R91.1.

13 policies

1 Cigna

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

5 Medicare

Billing and Coding: Computerized Axial Tomography (CT), Thorax
Policy ID: ART-56580
Billing and Coding: CT of the Head
Policy ID: ART-56612
Billing and Coding: BDX-XL2
Policy ID: ART-56929
Billing and Coding: Respiratory Care
Policy ID: ART-57224
Billing and Coding: BDX-XL2
Policy ID: ART-57356

3 Aetna

Tuberculosis Testing
Policy ID: CPB-0471
Lung Imaging: Selected Techniques
Policy ID: CPB-0581
Electromagnetic Navigation-Guided Bronchoscopy
Policy ID: CPB-0776

CPT Codes Commonly Billed with R91.1

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

4 linkages
  • 71250 CT chest without contrast — pulmonary nodule, lung mass, lung cancer, pulmonary mets, chronic cough, dyspnea, pneumothorax, PE, lung disease, hx lung cancer, bronchial neoplasm Radiology
  • 71260 CT chest with contrast — pulmonary embolism, chest pain, dyspnea, wheezing, pulmonary HTN, lung cancer, nodule, thrombophilia Radiology
  • 31622 Diagnostic bronchoscopy — pulmonary nodule, lung cancer, hemoptysis, lung disease, chronic cough, pneumonia, lung mets, abnormal sputum cytology Pulmonology
  • 0080U CMS LCD: Billing and Coding: BDX-XL2 CMS LCD

Convert R91.1 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
R91.1 79311 00000

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

ICD-10 R91.1, Billing FAQ

Is ICD-10 code R91.1 billable? +

Yes, R91.1 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 R91.1? +

ICD-10 R91.1 includes: Coin lesion lung; Solitary pulmonary nodule, subsegmental branch of the bronchial tree.

What CPT codes are commonly billed with R91.1? +

Procedures frequently paired with R91.1 include: 71250, 71260, 31622, 0080U.

What ICD-9 codes does R91.1 map to? +

Per CMS GEMs, R91.1 maps to ICD-9 codes: 79311. 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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