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

ICD-10 Z04.81

Billable / Specific

Encounter for examination and observation of victim following forced sexual exploitation

Z04
Block
0
Synonyms
537
LCDs
5
Payer Policies
0
Linked CPTs

About ICD-10-CM Z04.81

ICD-10-CM code Z04.81 represents Encounter for examination and observation of victim following forced sexual exploitation. This is a billable/specific code in the Factors Influencing Health Status chapter (block Z04). The 2026 edition of ICD-10-CM Z04.81 became effective on October 1, 2025.

Medicare LCD Coverage for Z04.81

Local Coverage Determinations (LCDs) from CMS MACs that list Z04.81 as a covered diagnosis.

537 LCDs

Showing top 10 of 537 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87555 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87653 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87486 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87626 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 0109U →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87516 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87517 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87528 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87476 →
CMS LCD: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Article ID: 58761, Effective: 2026-03-12 00:00:00, 851 covered, 0 non-covered
CPT 87594 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing Z04.81.

5 policies

1 Cigna

Nucleic Acid Pathogen Testing - (0530)
Policy ID: MM_0530

4 Medicare

Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Policy ID: ART-58710
Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Policy ID: ART-58720
Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Policy ID: ART-58747
Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Policy ID: ART-58761

CPT Codes Commonly Billed with Z04.81

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

No procedure linkages on file for Z04.81

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 Z04.81

Other codes in section Z00-Z13 (Persons encountering health services for examinations).

Z00 Encounter for general examination without complaint, suspected or reported diagnosis (non-billable) Z00.0 Encounter for general adult medical examination (non-billable) Z00.00 Encounter for general adult medical examination without abnormal findings Z00.01 Encounter for general adult medical examination with abnormal findings Z00.1 Encounter for newborn, infant and child health examinations (non-billable) Z00.11 Newborn health examination (non-billable) Z00.110 Health examination for newborn under 8 days old Z00.111 Health examination for newborn 8 to 28 days old Z00.12 Encounter for routine child health examination (non-billable) Z00.121 Encounter for routine child health examination with abnormal findings Z00.129 Encounter for routine child health examination without abnormal findings Z00.2 Encounter for examination for period of rapid growth in childhood Z00.3 Encounter for examination for adolescent development state Z00.5 Encounter for examination of potential donor of organ and tissue Z00.6 Encounter for examination for normal comparison and control in clinical research program Z00.7 Encounter for examination for period of delayed growth in childhood (non-billable) Z00.70 Encounter for examination for period of delayed growth in childhood without abnormal findings Z00.71 Encounter for examination for period of delayed growth in childhood with abnormal findings Z00.8 Encounter for other general examination Z01 Encounter for other special examination without complaint, suspected or reported diagnosis (non-billable)

ICD-10 Z04.81, Billing FAQ

Is ICD-10 code Z04.81 billable? +

Yes, Z04.81 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

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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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