G12.0: Infantile spinal muscular atrophy, type I [Werdnig-Hoffman]
G12.0, infantile spinal muscular atrophy, type I [Werdnig-Hoffman], is listed as a covered diagnosis in 11 Medicare billing and coding articles that apply to 23 HCPCS Level II codes, including A7020 (Interface for cough stimulating device, includes all…), E0483 (High frequency chest wall oscillation system, with full…), A7025 (High frequency chest wall oscillation system vest…). 4 of these codes have a 2026 DMEPOS fee schedule amount; A7020 pays $19.87 to $23.81 (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 G12.0 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| A7020 | Interface for cough stimulating device, includes all components, replacement only | Carrier judgment | $19.87–$23.81 (NU) | 1 |
| E0483 | High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each | Carrier judgment | $1,515.12–$1,818.13 (RR) | 1 |
| A7025 | High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each | Carrier judgment | $61.99–$74.42 (RR) | 1 |
| A7026 | High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each | Carrier judgment | $40.96–$49.15 (NU) | 1 |
| G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | Carrier judgment | — | 2 |
| A9585 | Injection, gadobutrol, 0.1 ml | Carrier judgment | — | 1 |
| Q9953 | Injection, iron-based magnetic resonance contrast agent, per ml | Special coverage instructions apply | — | 1 |
| G2187 | Patients with clinical indications for imaging of the head: head trauma | Carrier judgment | — | 1 |
| G2188 | Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age | Carrier judgment | — | 1 |
| G2189 | Patients with clinical indications for imaging of the head: abnormal neurologic exam | Carrier judgment | — | 1 |
| G2190 | Patients with clinical indications for imaging of the head: headache radiating to the neck | Carrier judgment | — | 1 |
| G2191 | Patients with clinical indications for imaging of the head: positional headaches | Carrier judgment | — | 1 |
| G2192 | Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age | Carrier judgment | — | 1 |
| G2193 | Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age) | Carrier judgment | — | 1 |
| G2194 | Patients 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 behavior | Carrier judgment | — | 1 |
| G2195 | Patients with clinical indications for imaging of the head: occipital headache in children | Carrier judgment | — | 1 |
| G0152 | Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
| G0158 | Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
| G0160 | Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes | Carrier judgment | — | 1 |
| G2169 | Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes | Carrier judgment | — | 1 |
| G0281 | Electrical 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 care | Carrier judgment | — | 1 |
| G0329 | Electromagnetic 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 care | Carrier judgment | — | 1 |
| G0255 | Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve | Non-covered by Medicare | Not covered | 5 |
Medicare policy articles listing G12.0
- A52510: Mechanical In-exsufflation Devices - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 1 Level II codes). LCD with the same title: L33795
- A52494: High Frequency Chest Wall Oscillation Devices - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 3 Level II codes). LCD with the same title: L33785
- A57307: Billing and Coding: Nerve Conduction Studies and Electromyography (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A57478: Billing and Coding: Nerve Conduction Studies and Electromyography (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A54969: Billing and Coding: Nerve Conduction Studies and Electromyography (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A57668: Billing and Coding: Nerve Conduction Studies and Electromyography (Wellpoint Federal (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A56619: Billing and Coding: Nerve Conduction Studies and Electromyography (Palmetto GBA (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A57206: Billing and Coding: Lumbar MRI (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L34220
- A56612: Billing and Coding: CT of the Head (Palmetto GBA (MAC - Part A, MAC - Part B); 9 Level II codes). LCD with the same title: L34417
- A53057: Billing and Coding: Home Health Occupational Therapy (Palmetto GBA (HHH MAC); 5 Level II codes). LCD with the same title: L34560
- A53064: Billing and Coding: Outpatient Occupational Therapy (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34427
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 G12 diagnoses (Spinal muscular atrophy and related syndromes)
- G12.1 — Other inherited spinal muscular atrophy
- G12.20 — Motor neuron disease, unspecified
- G12.21 — Amyotrophic lateral sclerosis
- G12.22 — Progressive bulbar palsy
- G12.23 — Primary lateral sclerosis
- G12.24 — Familial motor neuron disease
- G12.25 — Progressive spinal muscle atrophy
- G12.29 — Other motor neuron disease
- G12.8 — Other spinal muscular atrophies and related syndromes
- G12.9 — Spinal muscular atrophy, unspecified
Frequently asked questions
Does Medicare cover G12.0 (Infantile spinal muscular atrophy, type I [Werdnig-Hoffman])?
Medicare covers items and services, not diagnoses. 11 Medicare billing and coding articles list G12.0 as a covered diagnosis for 23 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 G12.0?
The Level II codes from the policies most specific to this diagnosis are A7020 (Interface for cough stimulating device, includes all…, 1 article); E0483 (High frequency chest wall oscillation system, with full…, 1 article); A7025 (High frequency chest wall oscillation system vest…, 1 article); A7026 (High frequency chest wall oscillation system hose…, 1 article); G0283 (Electrical stimulation (unattended), to one or more areas…, 2 articles). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with G12.0?
Under the 2026 DMEPOS fee schedule (non-rural state fees): A7020 $19.87 to $23.81 (NU); E0483 $1,515.12 to $1,818.13 (RR); A7025 $61.99 to $74.42 (RR); A7026 $40.96 to $49.15 (NU). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list G12.0?
A52510 (Mechanical In-exsufflation Devices - Policy Article); A52494 (High Frequency Chest Wall Oscillation Devices - Policy Article); A57307 (Billing and Coding: Nerve Conduction Studies and Electromyography), and 8 more articles.
What is ICD-10-CM code G12.0?
G12.0 is the ICD-10-CM code for infantile spinal muscular atrophy, type I [Werdnig-Hoffman], in category G12 (Spinal muscular atrophy and related syndromes), chapter 6: Diseases of the nervous system.
Next steps
- Run a reimbursement report for a device billed under A7020
- Watch A7020 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A7020
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