D81.31: Severe combined immunodeficiency due to adenosine deaminase deficiency
D81.31, severe combined immunodeficiency due to adenosine deaminase deficiency, is listed as a covered diagnosis in 7 Medicare billing and coding articles that apply to 21 HCPCS Level II codes, including J1559 (Injection, immune globulin (hizentra), 100 mg), J1555 (Injection, immune globulin (cuvitru), 100 mg), J1575 (Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg…). The articles come from 6 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with D81.31 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J1559 | Injection, immune globulin (hizentra), 100 mg | Carrier judgment | — | 2 |
| J1555 | Injection, immune globulin (cuvitru), 100 mg | Carrier judgment | — | 2 |
| J1575 | Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin | Carrier judgment | — | 2 |
| J1558 | Injection, immune globulin (xembify), 100 mg | Carrier judgment | — | 2 |
| J1569 | Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mg | Special coverage instructions apply | — | 2 |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 2 |
| J1551 | Injection, immune globulin (cutaquig), 100 mg | Carrier judgment | — | 2 |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 2 |
| J1576 | Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 2 |
| J1557 | Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 2 |
| J1556 | Injection, immune globulin (bivigam), 500 mg | Carrier judgment | — | 2 |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 2 |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg | Special coverage instructions apply | — | 2 |
| J1554 | Injection, immune globulin (asceniv), 500 mg | Carrier judgment | — | 2 |
| J1572 | Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 2 |
| J1552 | Injection, immune globulin (alyglo), 500 mg | Carrier judgment | — | 2 |
| J1553 | Injection, immune globulin (yimmugo), 100 mg | Carrier judgment | — | 2 |
| J1577 | Injection, immune globulin (qivigy), 100 mg | Carrier judgment | — | 2 |
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc | Carrier judgment | — | 4 |
| U0001 | Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel | Carrier judgment | — | 4 |
| G0127 | Trimming of dystrophic nails, any number | Special coverage instructions apply | — | 1 |
Medicare policy articles listing D81.31
- A56786: Billing and Coding: Immune Globulin (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 18 Level II codes). LCD with the same title: L34007, L35093
- A57778: Billing and Coding: Immune Globulin (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B); 18 Level II codes). LCD with the same title: L34007, L35093
- A57954: Billing and Coding: Routine Foot Care (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L33941, L35138, L37643
- A58710: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (Palmetto GBA (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58720: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58761: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58747: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other D81 diagnoses (Combined immunodeficiencies)
- D81.30 — Adenosine deaminase deficiency, unspecified
- D81.32 — Adenosine deaminase 2 deficiency
- D81.39 — Other adenosine deaminase deficiency
- D81.0 — Severe combined immunodeficiency [SCID] with reticular dysgenesis
- D81.1 — Severe combined immunodeficiency [SCID] with low T- and B-cell numbers
- D81.2 — Severe combined immunodeficiency [SCID] with low or normal B-cell…
- D81.4 — Nezelof's syndrome
- D81.5 — Purine nucleoside phosphorylase [PNP] deficiency
- D81.6 — Major histocompatibility complex class I deficiency
- D81.7 — Major histocompatibility complex class II deficiency
- D81.810 — Biotinidase deficiency
- D81.818 — Other biotin-dependent carboxylase deficiency
- D81.819 — Biotin-dependent carboxylase deficiency, unspecified
- D81.82 — Activated Phosphoinositide 3-kinase Delta Syndrome [APDS]
- D81.89 — Other combined immunodeficiencies
- D81.9 — Combined immunodeficiency, unspecified
Frequently asked questions
Does Medicare cover D81.31 (Severe combined immunodeficiency due to adenosine…)?
Medicare covers items and services, not diagnoses. 7 Medicare billing and coding articles list D81.31 as a covered diagnosis for 21 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 D81.31?
The Level II codes from the policies most specific to this diagnosis are J1559 (Injection, immune globulin (hizentra), 100 mg, 2 articles); J1555 (Injection, immune globulin (cuvitru), 100 mg, 2 articles); J1575 (Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg…, 2 articles); J1558 (Injection, immune globulin (xembify), 100 mg, 2 articles); J1569 (Injection, immune globulin, (gammagard liquid/gammagard…, 2 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list D81.31?
A56786 (Billing and Coding: Immune Globulin); A57778 (Billing and Coding: Immune Globulin); A57954 (Billing and Coding: Routine Foot Care), and 4 more articles.
What is ICD-10-CM code D81.31?
D81.31 is the ICD-10-CM code for severe combined immunodeficiency due to adenosine deaminase deficiency, in category D81 (Combined immunodeficiencies), chapter 3: Diseases of the blood and immune mechanism.
Next steps
- Run a reimbursement report for a device billed under J1559
- Watch J1559 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1559
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 3: Diseases of the blood and immune mechanism · All diagnoses · HCPCS lookup