G11.4: Hereditary spastic paraplegia

G11.4, hereditary spastic paraplegia, is listed as a covered diagnosis in 17 Medicare billing and coding articles that apply to 31 HCPCS Level II codes, including J0585 (Injection, onabotulinumtoxina, 1 unit), J0588 (Injection, incobotulinumtoxin a, 1 unit), J0586 (Injection, abobotulinumtoxina, 5 units). 4 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 7 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 G11.4 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
J0585Injection, onabotulinumtoxina, 1 unitSpecial coverage instructions apply—8
J0588Injection, incobotulinumtoxin a, 1 unitCarrier judgment—8
J0586Injection, abobotulinumtoxina, 5 unitsCarrier judgment—8
J0587Injection, rimabotulinumtoxinb, 100 unitsSpecial coverage instructions apply—8
J0589Injection, daxibotulinumtoxina-lanm, 1 unitCarrier judgment—8
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of careCarrier judgment—2
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
G2187Patients with clinical indications for imaging of the head: head traumaCarrier judgment—1
G2188Patients with clinical indications for imaging of the head: new or change in headache above 50 years of ageCarrier judgment—1
G2189Patients with clinical indications for imaging of the head: abnormal neurologic examCarrier judgment—1
G2190Patients with clinical indications for imaging of the head: headache radiating to the neckCarrier judgment—1
G2191Patients with clinical indications for imaging of the head: positional headachesCarrier judgment—1
G2192Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of ageCarrier judgment—1
G2193Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age)Carrier judgment—1
G2194Patients with clinical indications for imaging of the head: new onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behaviorCarrier judgment—1
G2195Patients with clinical indications for imaging of the head: occipital headache in childrenCarrier judgment—1
G0152Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutesCarrier judgment—1

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

Medicare policy articles listing G11.4

2 more articles list G11.4.

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 G11 diagnoses (Hereditary ataxia)

Frequently asked questions

Does Medicare cover G11.4 (Hereditary spastic paraplegia)?

Medicare covers items and services, not diagnoses. 17 Medicare billing and coding articles list G11.4 as a covered diagnosis for 31 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 G11.4?

The Level II codes from the policies most specific to this diagnosis are J0585 (Injection, onabotulinumtoxina, 1 unit, 8 articles); J0588 (Injection, incobotulinumtoxin a, 1 unit, 8 articles); J0586 (Injection, abobotulinumtoxina, 5 units, 8 articles); J0587 (Injection, rimabotulinumtoxinb, 100 units, 8 articles); J0589 (Injection, daxibotulinumtoxina-lanm, 1 unit, 8 articles). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with G11.4?

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 G11.4?

A57715 (Billing and Coding: Botulinum Toxins); A58423 (Billing and Coding: Botulinum Toxins); A57185 (Billing and Coding: Botulinum Toxin Injections), and 14 more articles.

What is ICD-10-CM code G11.4?

G11.4 is the ICD-10-CM code for hereditary spastic paraplegia, in category G11 (Hereditary ataxia), 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