J96.21: Acute and chronic respiratory failure with hypoxia

J96.21, acute and chronic respiratory failure with hypoxia, is listed as a covered diagnosis in 7 Medicare billing and coding articles that apply to 42 HCPCS Level II codes, including J0461 (Injection, atropine sulfate, 0.01 mg), J0153 (Injection, adenosine, 1 mg (not to be used to report any…), J1250 (Injection, dobutamine hydrochloride, per 250 mg). The articles come from 4 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 J96.21 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
J0461Injection, atropine sulfate, 0.01 mgSpecial coverage instructions apply—3
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)Special coverage instructions apply—3
J1250Injection, dobutamine hydrochloride, per 250 mgSpecial coverage instructions apply—3
J0280Injection, aminophyllin, up to 250 mgSpecial coverage instructions apply—3
J1245Injection, dipyridamole, per 10 mgSpecial coverage instructions apply—3
A9700Supply of injectable contrast material for use in echocardiography, per studySpecial coverage instructions apply—3
G0238Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)Carrier judgment—2
G0237Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)Carrier judgment—2
G0239Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)Carrier judgment—2
J2785Injection, regadenoson, 0.1 mgCarrier judgment—2
Q9957Injection, perflutren lipid microspheres, per mlCarrier judgment—2
Q9956Injection, octafluoropropane microspheres, per mlCarrier judgment—2
C8921Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; completeSpecial coverage instructions apply—2
C8922Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited studySpecial coverage instructions apply—2
C8923Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, without spectral or color doppler echocardiographySpecial coverage instructions apply—2
C8924Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited studySpecial coverage instructions apply—2
C8928Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and reportSpecial coverage instructions apply—2
C8929Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiographySpecial coverage instructions apply—2
C8930Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervisionSpecial coverage instructions apply—2
Q9955Injection, perflexane lipid microspheres, per mlCarrier judgment—2
G0278Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure)Carrier judgment—1
G0269Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug)Special coverage instructions apply—1
J3490Unclassified drugsSpecial coverage instructions apply—1
C9399Unclassified drugs or biologicalsSpecial coverage instructions apply—1
C8900Magnetic resonance angiography with contrast, abdomenSpecial coverage instructions apply—1

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

Medicare policy articles listing J96.21

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 J96 diagnoses (Respiratory failure, not elsewhere classified)

Frequently asked questions

Does Medicare cover J96.21 (Acute and chronic respiratory failure with hypoxia)?

Medicare covers items and services, not diagnoses. 7 Medicare billing and coding articles list J96.21 as a covered diagnosis for 42 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 J96.21?

The Level II codes from the policies most specific to this diagnosis are J0461 (Injection, atropine sulfate, 0.01 mg, 3 articles); J0153 (Injection, adenosine, 1 mg (not to be used to report any…, 3 articles); J1250 (Injection, dobutamine hydrochloride, per 250 mg, 3 articles); J0280 (Injection, aminophyllin, up to 250 mg, 3 articles); J1245 (Injection, dipyridamole, per 10 mg, 3 articles). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list J96.21?

A56500 (Billing and Coding: Cardiac Catheterization and Coronary Angiography); A56717 (Billing and Coding: Respiratory Therapy (Respiratory Care)); A57224 (Billing and Coding: Respiratory Care), and 4 more articles.

What is ICD-10-CM code J96.21?

J96.21 is the ICD-10-CM code for acute and chronic respiratory failure with hypoxia, in category J96 (Respiratory failure, not elsewhere classified), 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