G04.1: Tropical spastic paraplegia

G04.1, tropical spastic paraplegia, is listed as a covered diagnosis in 20 Medicare billing and coding articles that apply to 91 HCPCS Level II codes, including J0585 (Injection, onabotulinumtoxina, 1 unit), J0588 (Injection, incobotulinumtoxin a, 1 unit), J0586 (Injection, abobotulinumtoxina, 5 units). 51 of these codes have a 2026 DMEPOS fee schedule amount; E0783 pays $9,917.33 to $11,667.45 (NU) depending on the state. The articles come from 5 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 G04.1 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
J0585Injection, onabotulinumtoxina, 1 unitSpecial coverage instructions apply—6
J0588Injection, incobotulinumtoxin a, 1 unitCarrier judgment—6
J0586Injection, abobotulinumtoxina, 5 unitsCarrier judgment—6
J0587Injection, rimabotulinumtoxinb, 100 unitsSpecial coverage instructions apply—6
J0589Injection, daxibotulinumtoxina-lanm, 1 unitCarrier judgment—6
G0127Trimming of dystrophic nails, any numberSpecial coverage instructions apply—2
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of careCarrier judgment—3
E0783Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.)Special coverage instructions apply$9,917.33–$11,667.45 (NU)1
E0786Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)Special coverage instructions apply$10,969.75–$11,380.88 (NU)1
E0782Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.)Special coverage instructions apply$5,200.92–$6,118.73 (NU)1
E0785Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacementSpecial coverage instructions apply$572.38–$673.39 (KF)1
J7999Compounded drug, not otherwise classifiedSpecial coverage instructions apply—1
J2278Injection, ziconotide, 1 microgramSpecial coverage instructions apply—1
J2274Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mgSpecial coverage instructions apply—1
A4220Refill kit for implantable infusion pumpSpecial coverage instructions apply—1
J9200Injection, floxuridine, 500 mgSpecial coverage instructions apply—1
G0281Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of careCarrier judgment—2
G0329Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of careCarrier judgment—2
A9585Injection, gadobutrol, 0.1 mlCarrier judgment—1
Q9953Injection, iron-based magnetic resonance contrast agent, per mlSpecial coverage instructions apply—1
L1844Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricatedCarrier judgment$1,865.51–$2,436.241
L1860Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)Carrier judgment$1,233.07–$1,985.941
L1846Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricatedCarrier judgment$1,283.72–$1,960.171
L1834Knee orthosis, without knee joint, rigid, custom fabricatedCarrier judgment$892.02–$1,808.361
L1832Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertiseCarrier judgment$698.63–$1,618.031

66 more codes are listed. See every code with payment by region in Caduvo.

Medicare policy articles listing G04.1

5 more articles list G04.1.

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 G04 diagnoses (Encephalitis, myelitis and encephalomyelitis)

Frequently asked questions

Does Medicare cover G04.1 (Tropical spastic paraplegia)?

Medicare covers items and services, not diagnoses. 20 Medicare billing and coding articles list G04.1 as a covered diagnosis for 91 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 G04.1?

The Level II codes from the policies most specific to this diagnosis are J0585 (Injection, onabotulinumtoxina, 1 unit, 6 articles); J0588 (Injection, incobotulinumtoxin a, 1 unit, 6 articles); J0586 (Injection, abobotulinumtoxina, 5 units, 6 articles); J0587 (Injection, rimabotulinumtoxinb, 100 units, 6 articles); J0589 (Injection, daxibotulinumtoxina-lanm, 1 unit, 6 articles). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with G04.1?

Under the 2026 DMEPOS fee schedule (non-rural state fees): E0783 $9,917.33 to $11,667.45 (NU); E0786 $10,969.75 to $11,380.88 (NU); E0782 $5,200.92 to $6,118.73 (NU); E0785 $572.38 to $673.39 (KF). Medicare pays 80% of the allowed amount after the Part B deductible.

Which Medicare policy articles list G04.1?

A57759 (Billing and Coding: Routine Foot Care and Debridement of Nails); A57185 (Billing and Coding: Botulinum Toxin Injections); A57186 (Billing and Coding: Botulinum Toxin Injections), and 17 more articles.

What is ICD-10-CM code G04.1?

G04.1 is the ICD-10-CM code for tropical spastic paraplegia, in category G04 (Encephalitis, myelitis and encephalomyelitis), chapter 6: Diseases of the nervous system.

Next steps

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 6: Diseases of the nervous system · All diagnoses · HCPCS lookup