L40.1: Generalized pustular psoriasis
L40.1, generalized pustular psoriasis, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 10 HCPCS Level II codes, including J1745 (Injection, infliximab, excludes biosimilar, 10 mg), Q5104 (Injection, infliximab-abda, biosimilar, (renflexis), 10 mg), Q5103 (Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg). 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 L40.1 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | Special coverage instructions apply | — | 2 |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | Special coverage instructions apply | — | 2 |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | Special coverage instructions apply | — | 2 |
| Q5121 | Injection, infliximab-axxq, biosimilar, (avsola), 10 mg | Carrier judgment | — | 2 |
| J9312 | Injection, rituximab, 10 mg | Special coverage instructions apply | — | 2 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | Carrier judgment | — | 2 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | Carrier judgment | — | 2 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | Special coverage instructions apply | — | 2 |
| J9260 | Injection, methotrexate sodium, 50 mg | Special coverage instructions apply | — | 1 |
| J9215 | Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu | Special coverage instructions apply | — | 1 |
Medicare policy articles listing L40.1
- A56432: Billing and Coding: Infliximab (Palmetto GBA (MAC - Part A, MAC - Part B); 4 Level II codes). LCD with the same title: L35677
- A55639: Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 6 Level II codes)
- A52423: Billing and Coding: Infliximab and biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B); 4 Level II codes)
- A59101: Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B); 4 Level II codes). LCD with the same title: L38920, L39297
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 L40 diagnoses (Psoriasis)
- L40.0 — Psoriasis vulgaris
- L40.2 — Acrodermatitis continua
- L40.3 — Pustulosis palmaris et plantaris
- L40.4 — Guttate psoriasis
- L40.50 — Arthropathic psoriasis, unspecified
- L40.51 — Distal interphalangeal psoriatic arthropathy
- L40.52 — Psoriatic arthritis mutilans
- L40.53 — Psoriatic spondylitis
- L40.54 — Psoriatic juvenile arthropathy
- L40.59 — Other psoriatic arthropathy
- L40.8 — Other psoriasis
- L40.9 — Psoriasis, unspecified
Frequently asked questions
Does Medicare cover L40.1 (Generalized pustular psoriasis)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list L40.1 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 L40.1?
The Level II codes from the policies most specific to this diagnosis are J1745 (Injection, infliximab, excludes biosimilar, 10 mg, 2 articles); Q5104 (Injection, infliximab-abda, biosimilar, (renflexis), 10 mg, 2 articles); Q5103 (Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg, 2 articles); Q5121 (Injection, infliximab-axxq, biosimilar, (avsola), 10 mg, 2 articles); J9312 (Injection, rituximab, 10 mg, 2 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list L40.1?
A56432 (Billing and Coding: Infliximab); A55639 (Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions); A52423 (Billing and Coding: Infliximab and biosimilars), and 1 more article.
What is ICD-10-CM code L40.1?
L40.1 is the ICD-10-CM code for generalized pustular psoriasis, in category L40 (Psoriasis), chapter 12: Diseases of the skin and subcutaneous tissue.
Next steps
- Run a reimbursement report for a device billed under J1745
- Watch J1745 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1745
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 12: Diseases of the skin and subcutaneous tissue · All diagnoses · HCPCS lookup