I69.231: Monoplegia of upper limb following other nontraumatic intracranial hemorrhage affecting right dominant side

I69.231, monoplegia of upper limb following other nontraumatic intracranial hemorrhage affecting right dominant side, is listed as a covered diagnosis in 10 Medicare billing and coding articles that apply to 20 HCPCS Level II codes, including J0585 (Injection, onabotulinumtoxina, 1 unit), J0588 (Injection, incobotulinumtoxin a, 1 unit), J0586 (Injection, abobotulinumtoxina, 5 units). The articles come from 6 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 I69.231 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
J0585Injection, onabotulinumtoxina, 1 unitSpecial coverage instructions apply—6
J0588Injection, incobotulinumtoxin a, 1 unitCarrier judgment—6
J0586Injection, abobotulinumtoxina, 5 unitsCarrier judgment—6
J0587Injection, rimabotulinumtoxinb, 100 unitsSpecial coverage instructions apply—6
J0589Injection, daxibotulinumtoxina-lanm, 1 unitCarrier judgment—6
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of careCarrier judgment—3
G0451Development testing, with interpretation and report, per standardized instrument formCarrier judgment—1
G0017Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutesCarrier judgment—1
G0018Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service)Carrier judgment—1
G0560Safety planning interventions, each 20 minutes personally performed by the billing practitioner, including assisting the patient in the identification of the following personalized elements of a safety plan: recognizing warning signs of an impending suicidal or substance use-related crisis; employing internal coping strategies; utilizing social contacts and social settings as a means of distraction from suicidal thoughts or risky substance use; utilizing family members, significant others, caregivers, and/or friends to help resolve the crisis; contacting mental health or substance use disorder professionals or agencies; and making the environment safeCarrier judgment—1
G0281Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of careCarrier judgment—2
G0329Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of careCarrier judgment—2
G0152Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutesCarrier judgment—1
G0158Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutesCarrier judgment—1
G0160Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutesCarrier judgment—1
G2169Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutesCarrier judgment—1
G2010Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointmentCarrier judgment—1
G2250Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointmentCarrier judgment—1
G2251Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussionCarrier judgment—1
G0151Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutesCarrier judgment—1

Medicare policy articles listing I69.231

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 I69 diagnoses (Sequelae of cerebrovascular disease)

Frequently asked questions

Does Medicare cover I69.231 (Monoplegia of upper limb following other nontraumatic…)?

Medicare covers items and services, not diagnoses. 10 Medicare billing and coding articles list I69.231 as a covered diagnosis for 20 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 I69.231?

The Level II codes from the policies most specific to this diagnosis are J0585 (Injection, onabotulinumtoxina, 1 unit, 6 articles); J0588 (Injection, incobotulinumtoxin a, 1 unit, 6 articles); J0586 (Injection, abobotulinumtoxina, 5 units, 6 articles); J0587 (Injection, rimabotulinumtoxinb, 100 units, 6 articles); J0589 (Injection, daxibotulinumtoxina-lanm, 1 unit, 6 articles). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list I69.231?

A57185 (Billing and Coding: Botulinum Toxin Injections); A57186 (Billing and Coding: Botulinum Toxin Injections); A59707 (Billing and Coding: Botulinum Toxin Injections), and 7 more articles.

What is ICD-10-CM code I69.231?

I69.231 is the ICD-10-CM code for monoplegia of upper limb following other nontraumatic intracranial hemorrhage affecting right dominant side, in category I69 (Sequelae of cerebrovascular disease), 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