G72.89: Other specified myopathies
G72.89, other specified myopathies, is listed as a covered diagnosis in 11 Medicare billing and coding articles that apply to 32 HCPCS Level II codes, including J1569 (Injection, immune globulin, (gammagard liquid/gammagard…), J1561 (Injection, immune globulin, (gamunex-c/gammaked)…), J1459 (Injection, immune globulin (privigen), intravenous…). 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 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 G72.89 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| 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 |
| J1576 | Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 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 |
| J1552 | Injection, immune globulin (alyglo), 500 mg | Carrier judgment | — | 3 |
| 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 |
| J1551 | Injection, immune globulin (cutaquig), 100 mg | Carrier judgment | — | 2 |
| J1572 | Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 2 |
| J1553 | Injection, immune globulin (yimmugo), 100 mg | Carrier judgment | — | 2 |
| J1577 | Injection, immune globulin (qivigy), 100 mg | Carrier judgment | — | 2 |
| 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 |
| J1599 | Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg | Carrier judgment | — | 1 |
| 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 |
7 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing G72.89
- 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
- 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
- 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
- A56380: Billing and Coding: Rituximab (Palmetto GBA (MAC - Part A, MAC - Part B); 6 Level II codes). LCD with the same title: L35026
- 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
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)
- G72.81 — Critical illness myopathy
- G72.0 — Drug-induced myopathy
- G72.1 — Alcoholic myopathy
- G72.2 — Myopathy due to other toxic agents
- G72.3 — Periodic paralysis
- G72.41 — Inclusion body myositis [IBM]
- G72.49 — Other inflammatory and immune myopathies, not elsewhere classified
- G72.9 — Myopathy, unspecified
Frequently asked questions
Does Medicare cover G72.89 (Other specified myopathies)?
Medicare covers items and services, not diagnoses. 11 Medicare billing and coding articles list G72.89 as a covered diagnosis for 32 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 G72.89?
The Level II codes from the policies most specific to this diagnosis are J1569 (Injection, immune globulin, (gammagard liquid/gammagard…, 3 articles); J1561 (Injection, immune globulin, (gamunex-c/gammaked)…, 3 articles); J1459 (Injection, immune globulin (privigen), intravenous…, 3 articles); J1576 (Injection, immune globulin (panzyga), intravenous…, 3 articles); J1557 (Injection, immune globulin, (gammaplex), intravenous…, 3 articles). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with G72.89?
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 G72.89?
A52510 (Mechanical In-exsufflation Devices - Policy Article); A52494 (High Frequency Chest Wall Oscillation Devices - Policy Article); A56786 (Billing and Coding: Immune Globulin), and 8 more articles.
What is ICD-10-CM code G72.89?
G72.89 is the ICD-10-CM code for other specified myopathies, 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 J1569
- Watch J1569 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1569
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