G93.49: Other encephalopathy
G93.49, other encephalopathy, is listed as a covered diagnosis in 6 Medicare billing and coding articles that apply to 39 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…). 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 G93.49 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 | — | 4 |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 4 |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 4 |
| J1557 | Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 4 |
| J1556 | Injection, immune globulin (bivigam), 500 mg | Carrier judgment | — | 4 |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 4 |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg | Special coverage instructions apply | — | 4 |
| J1554 | Injection, immune globulin (asceniv), 500 mg | Carrier judgment | — | 4 |
| J1577 | Injection, immune globulin (qivigy), 100 mg | Carrier judgment | — | 4 |
| J1576 | Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 3 |
| J1575 | Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin | Carrier judgment | — | 3 |
| J1572 | Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 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 |
| J1558 | Injection, immune globulin (xembify), 100 mg | Carrier judgment | — | 2 |
| J1551 | Injection, immune globulin (cutaquig), 100 mg | Carrier judgment | — | 2 |
| J1553 | Injection, immune globulin (yimmugo), 100 mg | Carrier judgment | — | 2 |
| J1599 | Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg | Carrier judgment | — | 2 |
| J9312 | Injection, rituximab, 10 mg | Special coverage instructions apply | — | 1 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | Carrier judgment | — | 1 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | Carrier judgment | — | 1 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | Special coverage instructions apply | — | 1 |
| J1460 | Injection, gamma globulin, intramuscular, 1 cc | Special coverage instructions apply | — | 1 |
| J1670 | Injection, tetanus immune globulin, human, up to 250 units | Special coverage instructions apply | — | 1 |
14 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing G93.49
- 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
- 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
- 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
- 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
- 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
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 G93 diagnoses (Other disorders of brain)
- G93.45 — Developmental and epileptic encephalopathy
- G93.1 — Anoxic brain damage, not elsewhere classified
- G93.5 — Compression of brain
Frequently asked questions
Does Medicare cover G93.49 (Other encephalopathy)?
Medicare covers items and services, not diagnoses. 6 Medicare billing and coding articles list G93.49 as a covered diagnosis for 39 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 G93.49?
The Level II codes from the policies most specific to this diagnosis are J1569 (Injection, immune globulin, (gammagard liquid/gammagard…, 4 articles); J1561 (Injection, immune globulin, (gamunex-c/gammaked)…, 4 articles); J1459 (Injection, immune globulin (privigen), intravenous…, 4 articles); J1557 (Injection, immune globulin, (gammaplex), intravenous…, 4 articles); J1556 (Injection, immune globulin (bivigam), 500 mg, 4 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list G93.49?
A56786 (Billing and Coding: Immune Globulin); A57778 (Billing and Coding: Immune Globulin); A59105 (Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)), and 3 more articles.
What is ICD-10-CM code G93.49?
G93.49 is the ICD-10-CM code for other encephalopathy, in category G93 (Other disorders of brain), 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