ICD-10 Z42.1
Billable / SpecificEncounter for breast reconstruction following mastectomy
About ICD-10-CM Z42.1
ICD-10-CM code Z42.1 represents Encounter for breast reconstruction following mastectomy. This is a billable/specific code in the Factors Influencing Health Status chapter (block Z42). The 2026 edition of ICD-10-CM Z42.1 became effective on October 1, 2025.
Type 1 Excludes
Pure excludes, these codes can never be coded together with Z42.1. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- deformity and disproportion of reconstructed breast (N65.1-)
Medicare LCD Coverage for Z42.1
Local Coverage Determinations (LCDs) from CMS MACs that list Z42.1 as a covered diagnosis.
Showing top 10 of 375 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing Z42.1.
5 Medicare
CPT Codes Commonly Billed with Z42.1
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.
Convert Z42.1 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 |
|---|---|---|
| Z42.1 | V510 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To Z42.1
Other codes in section Z40-Z53 (Encounters for other specific health care).
ICD-10 Z42.1, Billing FAQ
Is ICD-10 code Z42.1 billable? +
Yes, Z42.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for Z42.1? +
Type 1 Excludes (never code together with Z42.1): deformity and disproportion of reconstructed breast (N65.1-)
What ICD-9 codes does Z42.1 map to? +
Per CMS GEMs, Z42.1 maps to ICD-9 codes: V510. 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 June 1, 2026.
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