K60.422: Rectal fistula, complex, persistent

K60.422, rectal fistula, complex, persistent, is listed as a covered diagnosis in 7 Medicare billing and coding articles that apply to 8 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 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 K60.422 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
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

Medicare policy articles listing K60.422

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 K60 diagnoses (Fissure and fistula of anal and rectal regions)

Frequently asked questions

Does Medicare cover K60.422 (Rectal fistula, complex, persistent)?

Medicare covers items and services, not diagnoses. 7 Medicare billing and coding articles list K60.422 as a covered diagnosis for 8 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 K60.422?

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 K60.422?

A57185 (Billing and Coding: Botulinum Toxin Injections); A57186 (Billing and Coding: Botulinum Toxin Injections); A59707 (Billing and Coding: Botulinum Toxin Injections), and 4 more articles.

What is ICD-10-CM code K60.422?

K60.422 is the ICD-10-CM code for rectal fistula, complex, persistent, in category K60 (Fissure and fistula of anal and rectal regions), 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