K52.1: Toxic gastroenteritis and colitis

K52.1, toxic gastroenteritis and colitis, is listed as a covered diagnosis in 9 Medicare billing and coding articles that apply to 11 HCPCS Level II codes, including U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19)…), U0001 (Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr…), J2353 (Injection, octreotide, depot form for intramuscular…). 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 K52.1 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
U00022019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdcCarrier judgment—4
U0001Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panelCarrier judgment—4
J2353Injection, octreotide, depot form for intramuscular injection, 1 mgCarrier judgment—1
J1745Injection, infliximab, excludes biosimilar, 10 mgSpecial coverage instructions apply—2
Q5104Injection, infliximab-abda, biosimilar, (renflexis), 10 mgSpecial coverage instructions apply—2
Q5103Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mgSpecial coverage instructions apply—2
Q5121Injection, infliximab-axxq, biosimilar, (avsola), 10 mgCarrier judgment—2
G0105Colorectal cancer screening; colonoscopy on individual at high riskSpecial coverage instructions apply—1
G9998Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes])Carrier judgment—1
G9999Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, patient cannot provide precise date or details from previous colonoscopy, previous colonoscopy report was incomplete)Carrier judgment—1
J0585Injection, onabotulinumtoxina, 1 unitSpecial coverage instructions apply—1

Medicare policy articles listing K52.1

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 K52 diagnoses (Other and unspecified noninfective gastroenteritis and colitis)

Frequently asked questions

Does Medicare cover K52.1 (Toxic gastroenteritis and colitis)?

Medicare covers items and services, not diagnoses. 9 Medicare billing and coding articles list K52.1 as a covered diagnosis for 11 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 K52.1?

The Level II codes from the policies most specific to this diagnosis are U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19)…, 4 articles); U0001 (Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr…, 4 articles); J2353 (Injection, octreotide, depot form for intramuscular…, 1 article); J1745 (Injection, infliximab, excludes biosimilar, 10 mg, 2 articles); Q5104 (Injection, infliximab-abda, biosimilar, (renflexis), 10 mg, 2 articles). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list K52.1?

A56531 (Billing and Coding: Octreotide Acetate for Injectable Suspension (Sandostatin® LAR Depot)); A56432 (Billing and Coding: Infliximab); A56632 (Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy), and 6 more articles.

What is ICD-10-CM code K52.1?

K52.1 is the ICD-10-CM code for toxic gastroenteritis and colitis, in category K52 (Other and unspecified noninfective gastroenteritis and colitis), chapter 11: Diseases of the digestive 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 11: Diseases of the digestive system · All diagnoses · HCPCS lookup