ICD-10 T38
Non-Billable HeaderPoisoning by, adverse effect of and underdosing of hormones and their synthetic substitutes and antagonists, not elsewhere classified
About ICD-10-CM T38
ICD-10-CM code T38 represents Poisoning by, adverse effect of and underdosing of hormones and their synthetic substitutes and antagonists, not elsewhere classified. This is a non-billable header code in the Injury, Poisoning, and External Causes chapter (block T38). The 2026 edition of ICD-10-CM T38 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Coding Tips for T38
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Injury codes require a 7th character: A (initial encounter, active treatment), D (subsequent, healing/recovery), S (sequela, late effect of original injury). Codes with fewer than 6 characters need the placeholder X to bring them to 6 characters before adding the 7th. Wrong or missing 7th character is the #1 cause of injury claim denials.
Type 1 Excludes
Pure excludes, these codes can never be coded together with T38. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- mineralocorticoids and their antagonists (T50.0-)
- oxytocic hormones (T48.0-)
- parathyroid hormones and derivatives (T50.9-)
Coding Notes
Seven Chr Note
- The appropriate 7th character is to be added to each code from category T38
Medicare LCD Coverage for T38
Local Coverage Determinations (LCDs) from CMS MACs that list T38 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 T38.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but T38 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with T38
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.
Codes Adjacent To T38
Other codes in section T36-T50 (Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances).
ICD-10 T38, Billing FAQ
Is ICD-10 code T38 billable? +
No, T38 is a non-billable header code. Use a more specific child code from block T38 when submitting claims.
What codes are Type 1 Excludes for T38? +
Type 1 Excludes (never code together with T38): mineralocorticoids and their antagonists (T50.0-); oxytocic hormones (T48.0-); parathyroid hormones and derivatives (T50.9-)
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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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