G72.49: Other inflammatory and immune myopathies, not elsewhere classified
G72.49, other inflammatory and immune myopathies, not elsewhere classified, is listed as a covered diagnosis in 18 Medicare billing and coding articles that apply to 46 HCPCS Level II codes, including J9312 (Injection, rituximab, 10 mg), Q5119 (Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg), Q5115 (Injection, rituximab-abbs, biosimilar, (truxima), 10 mg). 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 G72.49 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J9312 | Injection, rituximab, 10 mg | Special coverage instructions apply | — | 4 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | Carrier judgment | — | 4 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | Special coverage instructions apply | — | 4 |
| J1569 | Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mg | Special coverage instructions apply | — | 3 |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 3 |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 3 |
| J1557 | Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 3 |
| J1556 | Injection, immune globulin (bivigam), 500 mg | Carrier judgment | — | 3 |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 3 |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg | Special coverage instructions apply | — | 3 |
| J1554 | Injection, immune globulin (asceniv), 500 mg | Carrier judgment | — | 3 |
| J1599 | Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg | Carrier judgment | — | 3 |
| J1576 | Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 2 |
| A7020 | Interface for cough stimulating device, includes all components, replacement only | Carrier judgment | $19.87–$23.81 (NU) | 1 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | Carrier judgment | — | 3 |
| 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 |
| J1552 | Injection, immune globulin (alyglo), 500 mg | Carrier judgment | — | 2 |
| J1577 | Injection, immune globulin (qivigy), 100 mg | Carrier judgment | — | 2 |
| J2791 | Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu | Special coverage instructions apply | — | 1 |
| J2792 | Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu | Special coverage instructions apply | — | 1 |
| G0238 | Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) | Carrier judgment | — | 2 |
| G0237 | Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring) | Carrier judgment | — | 2 |
| G0239 | Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring) | Carrier judgment | — | 2 |
21 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing G72.49
- A58582: Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L38920, L39297
- 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
- A56718: Billing and Coding: Intravenous Immunoglobulin (IVIG) (Palmetto GBA (MAC - Part A, MAC - Part B); 13 Level II codes). LCD with the same title: L34580
- A59105: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG) (Wellpoint Federal (MAC - Part A, MAC - Part B); 11 Level II codes). LCD with the same title: L39314
- A55639: Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 6 Level II codes)
- A56380: Billing and Coding: Rituximab (Palmetto GBA (MAC - Part A, MAC - Part B); 6 Level II codes). LCD with the same title: L35026
- A56717: Billing and Coding: Respiratory Therapy (Respiratory Care) (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34430
- A59101: Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B); 4 Level II codes). LCD with the same title: L38920, L39297
- A57224: Billing and Coding: Respiratory Care (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L34149
- 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
- A57554: Billing and Coding: Immune Globulins (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 20 Level II codes). LCD with the same title: L34771
- 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
3 more articles list G72.49.
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 G72 diagnoses (Other and unspecified myopathies)
- G72.41 — Inclusion body myositis [IBM]
- G72.0 — Drug-induced myopathy
- G72.1 — Alcoholic myopathy
- G72.2 — Myopathy due to other toxic agents
- G72.3 — Periodic paralysis
- G72.81 — Critical illness myopathy
- G72.89 — Other specified myopathies
- G72.9 — Myopathy, unspecified
Frequently asked questions
Does Medicare cover G72.49 (Other inflammatory and immune myopathies, not elsewhere…)?
Medicare covers items and services, not diagnoses. 18 Medicare billing and coding articles list G72.49 as a covered diagnosis for 46 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 G72.49?
The Level II codes from the policies most specific to this diagnosis are J9312 (Injection, rituximab, 10 mg, 4 articles); Q5119 (Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg, 4 articles); Q5115 (Injection, rituximab-abbs, biosimilar, (truxima), 10 mg, 4 articles); J1569 (Injection, immune globulin, (gammagard liquid/gammagard…, 3 articles); J1561 (Injection, immune globulin, (gamunex-c/gammaked)…, 3 articles). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with G72.49?
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 G72.49?
A58582 (Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars); A52510 (Mechanical In-exsufflation Devices - Policy Article); A52494 (High Frequency Chest Wall Oscillation Devices - Policy Article), and 15 more articles.
What is ICD-10-CM code G72.49?
G72.49 is the ICD-10-CM code for other inflammatory and immune myopathies, not elsewhere classified, in category G72 (Other and unspecified myopathies), chapter 6: Diseases of the nervous system.
Next steps
- Run a reimbursement report for a device billed under J9312
- Watch J9312 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9312
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