I42.7: Cardiomyopathy due to drug and external agent
I42.7, cardiomyopathy due to drug and external agent, is listed as a covered diagnosis in 14 Medicare billing and coding articles that apply to 49 HCPCS Level II codes, including C8925 (Transesophageal echocardiography (tee) with contrast, or…), C8926 (Transesophageal echocardiography (tee) with contrast, or…), C8927 (Transesophageal echocardiography (tee) with contrast, or…). 5 of these codes have a 2026 DMEPOS fee schedule amount; K0606 pays $3,588.90 (RR) 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 I42.7 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| C8925 | Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, real time with image documentation (2d) (with or without m-mode recording); including probe placement, image acquisition, interpretation and report | Special coverage instructions apply | — | 4 |
| C8926 | Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report | Special coverage instructions apply | — | 4 |
| C8927 | Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis | Special coverage instructions apply | — | 4 |
| J0153 | Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) | Special coverage instructions apply | — | 5 |
| J1250 | Injection, dobutamine hydrochloride, per 250 mg | Special coverage instructions apply | — | 5 |
| J1245 | Injection, dipyridamole, per 10 mg | Special coverage instructions apply | — | 5 |
| J0461 | Injection, atropine sulfate, 0.01 mg | Special coverage instructions apply | — | 4 |
| J0280 | Injection, aminophyllin, up to 250 mg | Special coverage instructions apply | — | 4 |
| C7539 | Insertion of new or replacement of permanent pacemaker with atrial and ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) | Special coverage instructions apply | — | 1 |
| C7538 | Insertion of new or replacement of permanent pacemaker with ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) | Special coverage instructions apply | — | 1 |
| C7540 | Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator, dual lead system, with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) | Carrier judgment | — | 1 |
| C7537 | Insertion of new or replacement of permanent pacemaker with atrial transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) | Special coverage instructions apply | — | 1 |
| G0448 | Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing | Carrier judgment | — | 1 |
| K0606 | Automatic external defibrillator, with integrated electrocardiogram analysis, garment type | Carrier judgment | $3,588.90 (RR) | 1 |
| K0609 | Replacement electrodes for use with automated external defibrillator, garment type only, each | Carrier judgment | $1,148.78–$1,378.59 | 1 |
| E0617 | External defibrillator with integrated electrocardiogram analysis | Carrier judgment | $433.30–$577.30 (RR) | 1 |
| K0608 | Replacement garment for use with automated external defibrillator, each | Carrier judgment | $172.74–$230.11 (NU) | 1 |
| K0607 | Replacement battery for automated external defibrillator, garment type only, each | Carrier judgment | $27.69–$36.87 (RR) | 1 |
| A9999 | Miscellaneous dme supply or accessory, not otherwise specified | Carrier judgment | — | 1 |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | Carrier judgment | — | 2 |
| A9502 | Technetium tc-99m tetrofosmin, diagnostic, per study dose | Carrier judgment | — | 2 |
| A9505 | Thallium tl-201 thallous chloride, diagnostic, per millicurie | Carrier judgment | — | 2 |
| A9501 | Technetium tc-99m teboroxime, diagnostic, per study dose | Carrier judgment | — | 2 |
| Q9957 | Injection, perflutren lipid microspheres, per ml | Carrier judgment | — | 3 |
| Q9956 | Injection, octafluoropropane microspheres, per ml | Carrier judgment | — | 3 |
24 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing I42.7
- A56391: Billing and Coding: Implantable Automatic Defibrillators (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 5 Level II codes)
- A52458: Automatic External Defibrillators - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 7 Level II codes). LCD with the same title: L33690
- A56743: Billing and Coding: Cardiovascular Nuclear Medicine (Wellpoint Federal (MAC - Part A, MAC - Part B); 9 Level II codes). LCD with the same title: L33560, L33960
- A57179: Billing and Coding: Transesophageal Echocardiogram (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L33756
- A56809: Billing and Coding: Transesophageal Echocardiography (TEE) (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L33579, L34337, L35016
- A56505: Billing and Coding: Transesophageal Echocardiography (TEE) (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 6 Level II codes). LCD with the same title: L33579, L34337, L35016
- A57183: Billing and Coding: Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 4 Level II codes). LCD with the same title: L34324
- A56500: Billing and Coding: Cardiac Catheterization and Coronary Angiography (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L33557, L33959
- A56476: Billing and Coding: Cardiac Radionuclide Imaging (Palmetto GBA (MAC - Part A, MAC - Part B); 13 Level II codes). LCD with the same title: L33457
- A52850: Billing and Coding: Cardiac Catheterization and Coronary Angiography (Wellpoint Federal (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L33557, L33959
- A52868: Billing and Coding: Transesophageal Echocardiography (TEE) (Wellpoint Federal (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L33579, L34337, L35016
- A57306: Billing and Coding: Transthoracic Echocardiography (TTE) (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 19 Level II codes). LCD with the same title: L33577, L34338
- A56781: Billing and Coding: Transthoracic Echocardiography (TTE) (Wellpoint Federal (MAC - Part A, MAC - Part B); 17 Level II codes). LCD with the same title: L33577, L34338
- A56625: Billing and Coding: Echocardiography (Palmetto GBA (MAC - Part A, MAC - Part B); 6 Level II codes). LCD with the same title: L37379
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 I42 diagnoses (Cardiomyopathy)
- I42.0 — Dilated cardiomyopathy
- I42.1 — Obstructive hypertrophic cardiomyopathy
- I42.2 — Other hypertrophic cardiomyopathy
- I42.3 — Endomyocardial (eosinophilic) disease
- I42.4 — Endocardial fibroelastosis
- I42.5 — Other restrictive cardiomyopathy
- I42.6 — Alcoholic cardiomyopathy
- I42.8 — Other cardiomyopathies
- I42.9 — Cardiomyopathy, unspecified
Frequently asked questions
Does Medicare cover I42.7 (Cardiomyopathy due to drug and external agent)?
Medicare covers items and services, not diagnoses. 14 Medicare billing and coding articles list I42.7 as a covered diagnosis for 49 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 I42.7?
The Level II codes from the policies most specific to this diagnosis are C8925 (Transesophageal echocardiography (tee) with contrast, or…, 4 articles); C8926 (Transesophageal echocardiography (tee) with contrast, or…, 4 articles); C8927 (Transesophageal echocardiography (tee) with contrast, or…, 4 articles); J0153 (Injection, adenosine, 1 mg (not to be used to report any…, 5 articles); J1250 (Injection, dobutamine hydrochloride, per 250 mg, 5 articles). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with I42.7?
Under the 2026 DMEPOS fee schedule (non-rural state fees): K0606 $3,588.90 (RR); K0609 $1,148.78 to $1,378.59; E0617 $433.30 to $577.30 (RR); K0608 $172.74 to $230.11 (NU). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list I42.7?
A56391 (Billing and Coding: Implantable Automatic Defibrillators); A52458 (Automatic External Defibrillators - Policy Article); A56743 (Billing and Coding: Cardiovascular Nuclear Medicine), and 11 more articles.
What is ICD-10-CM code I42.7?
I42.7 is the ICD-10-CM code for cardiomyopathy due to drug and external agent, in category I42 (Cardiomyopathy), chapter 9: Diseases of the circulatory system.
Next steps
- Run a reimbursement report for a device billed under C8925
- Watch C8925 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for C8925
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 9: Diseases of the circulatory system · All diagnoses · HCPCS lookup