J81.1: Chronic pulmonary edema

J81.1, chronic pulmonary edema, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 10 HCPCS Level II codes, including G0238 (Therapeutic procedures to improve respiratory function…), G0237 (Therapeutic procedures to increase strength or endurance…), G0239 (Therapeutic procedures to improve respiratory function or…). The articles come from 3 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 J81.1 as a covered diagnosis

Code	Description	Medicare coverage	DMEPOS fee 2026 (state range)	Articles listing it
G0238	Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)	Carrier judgment	—	2
G0237	Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)	Carrier judgment	—	2
G0239	Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)	Carrier judgment	—	2
G0283	Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care	Carrier judgment	—	1
G2010	Remote 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 appointment	Carrier judgment	—	1
G2250	Remote 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 appointment	Carrier judgment	—	1
G0281	Electrical 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 care	Carrier judgment	—	1
G2251	Brief 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 discussion	Carrier judgment	—	1
G0151	Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes	Carrier judgment	—	1
G0329	Electromagnetic 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 care	Carrier judgment	—	1

Medicare policy articles listing J81.1

A56717: Billing and Coding: Respiratory Therapy (Respiratory Care) (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34430
A57224: Billing and Coding: Respiratory Care (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L34149
A57311: Billing and Coding: Physical Therapy - Home Health (CGS Administrators, LLC (HHH MAC); 7 Level II codes). LCD with the same title: L33942

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 J81 diagnoses (Pulmonary edema)

J81.0 — Acute pulmonary edema

Frequently asked questions

Does Medicare cover J81.1 (Chronic pulmonary edema)?

Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list J81.1 as a covered diagnosis for 10 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 J81.1?

The Level II codes from the policies most specific to this diagnosis are G0238 (Therapeutic procedures to improve respiratory function…, 2 articles); G0237 (Therapeutic procedures to increase strength or endurance…, 2 articles); G0239 (Therapeutic procedures to improve respiratory function or…, 2 articles); G0283 (Electrical stimulation (unattended), to one or more areas…, 1 article); G2010 (Remote evaluation of recorded video and/or images…, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list J81.1?

A56717 (Billing and Coding: Respiratory Therapy (Respiratory Care)); A57224 (Billing and Coding: Respiratory Care); A57311 (Billing and Coding: Physical Therapy - Home Health).

What is ICD-10-CM code J81.1?

J81.1 is the ICD-10-CM code for chronic pulmonary edema, in category J81 (Pulmonary edema), chapter 10: Diseases of the respiratory 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 10: Diseases of the respiratory system · All diagnoses · HCPCS lookup