I50.43: Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure

I50.43, acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure, is listed as a covered diagnosis in 13 Medicare billing and coding articles that apply to 49 HCPCS Level II codes, including J0153 (Injection, adenosine, 1 mg (not to be used to report any…), J1250 (Injection, dobutamine hydrochloride, per 250 mg), J1245 (Injection, dipyridamole, per 10 mg). 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 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 I50.43 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)Special coverage instructions apply—6
J1250Injection, dobutamine hydrochloride, per 250 mgSpecial coverage instructions apply—6
J1245Injection, dipyridamole, per 10 mgSpecial coverage instructions apply—6
A9500Technetium tc-99m sestamibi, diagnostic, per study doseCarrier judgment—3
A9502Technetium tc-99m tetrofosmin, diagnostic, per study doseCarrier judgment—3
A9505Thallium tl-201 thallous chloride, diagnostic, per millicurieCarrier judgment—3
A9501Technetium tc-99m teboroxime, diagnostic, per study doseCarrier judgment—3
J3490Unclassified drugsSpecial coverage instructions apply—3
A9512Technetium tc-99m pertechnetate, diagnostic, per millicurieCarrier judgment—2
A9560Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuriesCarrier judgment—2
A9538Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuriesCarrier judgment—2
J2785Injection, regadenoson, 0.1 mgCarrier judgment—3
J0461Injection, atropine sulfate, 0.01 mgSpecial coverage instructions apply—4
J0280Injection, aminophyllin, up to 250 mgSpecial coverage instructions apply—4
C7539Insertion 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
C7538Insertion 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
C7540Removal 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
C7537Insertion 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
G0448Insertion 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 pacingCarrier judgment—1
K0606Automatic external defibrillator, with integrated electrocardiogram analysis, garment typeCarrier judgment$3,588.90 (RR)1
K0609Replacement electrodes for use with automated external defibrillator, garment type only, eachCarrier judgment$1,148.78–$1,378.591
E0617External defibrillator with integrated electrocardiogram analysisCarrier judgment$433.30–$577.30 (RR)1
K0608Replacement garment for use with automated external defibrillator, eachCarrier judgment$172.74–$230.11 (NU)1
K0607Replacement battery for automated external defibrillator, garment type only, eachCarrier judgment$27.69–$36.87 (RR)1
A9999Miscellaneous dme supply or accessory, not otherwise specifiedCarrier judgment—1

24 more codes are listed. See every code with payment by region in Caduvo.

Medicare policy articles listing I50.43

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 I50 diagnoses (Heart failure)

Frequently asked questions

Does Medicare cover I50.43 (Acute on chronic combined systolic (congestive) and…)?

Medicare covers items and services, not diagnoses. 13 Medicare billing and coding articles list I50.43 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 I50.43?

The Level II codes from the policies most specific to this diagnosis are J0153 (Injection, adenosine, 1 mg (not to be used to report any…, 6 articles); J1250 (Injection, dobutamine hydrochloride, per 250 mg, 6 articles); J1245 (Injection, dipyridamole, per 10 mg, 6 articles); A9500 (Technetium tc-99m sestamibi, diagnostic, per study dose, 3 articles); A9502 (Technetium tc-99m tetrofosmin, diagnostic, per study dose, 3 articles). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with I50.43?

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 I50.43?

A56391 (Billing and Coding: Implantable Automatic Defibrillators); A52458 (Automatic External Defibrillators - Policy Article); A56494 (Billing and Coding: Cardiovascular Nuclear Medicine), and 10 more articles.

What is ICD-10-CM code I50.43?

I50.43 is the ICD-10-CM code for acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure, in category I50 (Heart failure), chapter 9: Diseases of the circulatory system.

Next steps

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