ICD-10 Z42
Non-Billable HeaderEncounter for plastic and reconstructive surgery following medical procedure or healed injury
About ICD-10-CM Z42
ICD-10-CM code Z42 represents Encounter for plastic and reconstructive surgery following medical procedure or healed injury. This is a non-billable header code in the Factors Influencing Health Status chapter (block Z42). The 2026 edition of ICD-10-CM Z42 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.
Type 1 Excludes
Pure excludes, these codes can never be coded together with Z42. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- encounter for cosmetic plastic surgery (Z41.1)
- encounter for plastic surgery for treatment of current injury - code to relevent injury
Medicare LCD Coverage for Z42
Local Coverage Determinations (LCDs) from CMS MACs that list Z42 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 Z42.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but Z42 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with Z42
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 Z42
Other codes in section Z40-Z53 (Encounters for other specific health care).
ICD-10 Z42, Billing FAQ
Is ICD-10 code Z42 billable? +
No, Z42 is a non-billable header code. Use a more specific child code from block Z42 when submitting claims.
What codes are Type 1 Excludes for Z42? +
Type 1 Excludes (never code together with Z42): encounter for cosmetic plastic surgery (Z41.1); encounter for plastic surgery for treatment of current injury - code to relevent injury
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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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