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

ICD-10 Z96.642

Billable / Specific

Presence of left artificial hip joint

Z96
Block
0
Synonyms
390
LCDs
11
Payer Policies
2
Linked CPTs

About ICD-10-CM Z96.642

ICD-10-CM code Z96.642 represents Presence of left artificial hip joint. This is a billable/specific code in the Factors Influencing Health Status chapter (block Z96). The 2026 edition of ICD-10-CM Z96.642 became effective on October 1, 2025.

Medicare LCD Coverage for Z96.642

Local Coverage Determinations (LCDs) from CMS MACs that list Z96.642 as a covered diagnosis.

390 LCDs

Showing top 10 of 390 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Total Joint Arthroplasty
Article ID: 60249, Effective: , 1313 covered, 0 non-covered
CPT 27134 →
CMS LCD: Billing and Coding: Total Joint Arthroplasty
Article ID: 60249, Effective: , 1313 covered, 0 non-covered
CPT 20985 →
CMS LCD: Billing and Coding: Total Joint Arthroplasty
Article ID: 60249, Effective: , 1313 covered, 0 non-covered
CPT S2900 →
CMS LCD: Billing and Coding: Total Joint Arthroplasty
Article ID: 60249, Effective: , 1313 covered, 0 non-covered
CPT 27130 →
CMS LCD: Billing and Coding: Total Joint Arthroplasty
Article ID: 60249, Effective: , 1313 covered, 0 non-covered
CPT 27487 →
CMS LCD: Billing and Coding: Total Joint Arthroplasty
Article ID: 60249, Effective: , 1313 covered, 0 non-covered
CPT 27137 →
CMS LCD: Billing and Coding: Total Joint Arthroplasty
Article ID: 60249, Effective: , 1313 covered, 0 non-covered
CPT 27486 →
CMS LCD: Billing and Coding: Total Joint Arthroplasty
Article ID: 60249, Effective: , 1313 covered, 0 non-covered
CPT 27138 →
CMS LCD: Billing and Coding: Total Joint Arthroplasty
Article ID: 60249, Effective: , 1313 covered, 0 non-covered
CPT 0055T →
CMS LCD: Billing and Coding: Total Joint Arthroplasty
Article ID: 60249, Effective: , 1313 covered, 0 non-covered
CPT 27445 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing Z96.642.

11 policies

5 Medicare

Billing and Coding: Home Health Occupational Therapy
Policy ID: ART-53057
Billing and Coding: Home Health Physical Therapy
Policy ID: ART-53058
Billing and Coding: Outpatient Occupational Therapy
Policy ID: ART-53064
Billing and Coding: Outpatient Physical Therapy
Policy ID: ART-53065
Billing and Coding: Total Joint Arthroplasty
Policy ID: ART-56777

CPT Codes Commonly Billed with Z96.642

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

2 linkages
  • 97110 Therapeutic exercises — back pain, neck pain, joint pain, rotator cuff, knee OA, limb pain, meniscal tear, shoulder injury, ankle sprain, hemiplegia, paraplegia, post joint replacement, muscle weakness Physical Therapy
  • 97530 Therapeutic activities — post knee/hip replacement, post fracture, hemiplegia, post-stroke, MS — functional tasks Physical Therapy

Convert Z96.642 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
Z96.642 V4364 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

Codes Adjacent To Z96.642

Other codes in section Z77-Z99 (Persons with potential health hazards related to family and personal history and certain conditions influencing health status).

Z77 Other contact with and (suspected) exposures hazardous to health (non-billable) Z77.0 Contact with and (suspected) exposure to hazardous, chiefly nonmedicinal, chemicals (non-billable) Z77.01 Contact with and (suspected) exposure to hazardous metals (non-billable) Z77.010 Contact with and (suspected) exposure to arsenic Z77.011 Contact with and (suspected) exposure to lead Z77.012 Contact with and (suspected) exposure to uranium Z77.018 Contact with and (suspected) exposure to other hazardous metals Z77.02 Contact with and (suspected) exposure to hazardous aromatic compounds (non-billable) Z77.020 Contact with and (suspected) exposure to aromatic amines Z77.021 Contact with and (suspected) exposure to benzene Z77.028 Contact with and (suspected) exposure to other hazardous aromatic compounds Z77.09 Contact with and (suspected) exposure to other hazardous, chiefly nonmedicinal, chemicals (non-billable) Z77.090 Contact with and (suspected) exposure to asbestos Z77.098 Contact with and (suspected) exposure to other hazardous, chiefly nonmedicinal, chemicals Z77.1 Contact with and (suspected) exposure to environmental pollution and hazards in the physical environment (non-billable) Z77.11 Contact with and (suspected) exposure to environmental pollution (non-billable) Z77.110 Contact with and (suspected) exposure to air pollution Z77.111 Contact with and (suspected) exposure to water pollution Z77.112 Contact with and (suspected) exposure to soil pollution Z77.118 Contact with and (suspected) exposure to other environmental pollution

ICD-10 Z96.642, Billing FAQ

Is ICD-10 code Z96.642 billable? +

Yes, Z96.642 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 Z96.642? +

Procedures frequently paired with Z96.642 include: 97110, 97530.

What ICD-9 codes does Z96.642 map to? +

Per CMS GEMs, Z96.642 maps to ICD-9 codes: V4364. 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 May 31, 2026.

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