ICD-10 Z12.5
Billable / SpecificEncounter for screening for malignant neoplasm of prostate
About ICD-10-CM Z12.5
ICD-10-CM code Z12.5 represents Encounter for screening for malignant neoplasm of prostate. This is a billable/specific code in the Factors Influencing Health Status chapter (block Z12). The 2026 edition of ICD-10-CM Z12.5 became effective on October 1, 2025.
Medicare LCD Coverage for Z12.5
Local Coverage Determinations (LCDs) from CMS MACs that list Z12.5 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 Z12.5.
2 Cigna
2 Aetna
CPT Codes Commonly Billed with Z12.5
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 55700 Prostate biopsy — elevated PSA, prostate disorder, prostate cancer, family hx prostate cancer, urinary retention, prostate screening Urology
Convert Z12.5 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| Z12.5 | V7644 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To Z12.5
Other codes in section Z00-Z13 (Persons encountering health services for examinations).
ICD-10 Z12.5, Billing FAQ
Is ICD-10 code Z12.5 billable? +
Yes, Z12.5 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 Z12.5? +
Procedures frequently paired with Z12.5 include: 55700.
What ICD-9 codes does Z12.5 map to? +
Per CMS GEMs, Z12.5 maps to ICD-9 codes: V7644. 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 July 17, 2026.
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