L51.3: Stevens-Johnson syndrome-toxic epidermal necrolysis overlap syndrome
L51.3, stevens-Johnson syndrome-toxic epidermal necrolysis overlap syndrome, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 26 HCPCS Level II codes, including J1575 (Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg…), J1569 (Injection, immune globulin, (gammagard liquid/gammagard…), J1561 (Injection, immune globulin, (gamunex-c/gammaked)…). 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 L51.3 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J1575 | Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin | Carrier judgment | — | 3 |
| J1569 | Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mg | Special coverage instructions apply | — | 3 |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 3 |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 3 |
| J1557 | Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 3 |
| J1556 | Injection, immune globulin (bivigam), 500 mg | Carrier judgment | — | 3 |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 3 |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg | Special coverage instructions apply | — | 3 |
| J1554 | Injection, immune globulin (asceniv), 500 mg | Carrier judgment | — | 3 |
| J1572 | Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 3 |
| J1552 | Injection, immune globulin (alyglo), 500 mg | Carrier judgment | — | 3 |
| J1577 | Injection, immune globulin (qivigy), 100 mg | Carrier judgment | — | 3 |
| J1559 | Injection, immune globulin (hizentra), 100 mg | Carrier judgment | — | 2 |
| J1555 | Injection, immune globulin (cuvitru), 100 mg | Carrier judgment | — | 2 |
| J1558 | Injection, immune globulin (xembify), 100 mg | Carrier judgment | — | 2 |
| J1551 | Injection, immune globulin (cutaquig), 100 mg | Carrier judgment | — | 2 |
| J1576 | Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 2 |
| J1553 | Injection, immune globulin (yimmugo), 100 mg | Carrier judgment | — | 2 |
| J1599 | Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg | Carrier judgment | — | 1 |
| J1460 | Injection, gamma globulin, intramuscular, 1 cc | Special coverage instructions apply | — | 1 |
| J1670 | Injection, tetanus immune globulin, human, up to 250 units | Special coverage instructions apply | — | 1 |
| J0840 | Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram | Carrier judgment | — | 1 |
| J0850 | Injection, cytomegalovirus immune globulin intravenous (human), per vial | Special coverage instructions apply | — | 1 |
| J1560 | Injection, gamma globulin, intramuscular, over 10 cc | Special coverage instructions apply | — | 1 |
| J1571 | Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml | Special coverage instructions apply | — | 1 |
1 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing L51.3
- A56786: Billing and Coding: Immune Globulin (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 18 Level II codes). LCD with the same title: L34007, L35093
- A57778: Billing and Coding: Immune Globulin (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B); 18 Level II codes). LCD with the same title: L34007, L35093
- A57554: Billing and Coding: Immune Globulins (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 20 Level II codes). LCD with the same title: L34771
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 L51 diagnoses (Erythema multiforme)
Frequently asked questions
Does Medicare cover L51.3 (Stevens-Johnson syndrome-toxic epidermal necrolysis…)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list L51.3 as a covered diagnosis for 26 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 L51.3?
The Level II codes from the policies most specific to this diagnosis are J1575 (Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg…, 3 articles); J1569 (Injection, immune globulin, (gammagard liquid/gammagard…, 3 articles); J1561 (Injection, immune globulin, (gamunex-c/gammaked)…, 3 articles); J1459 (Injection, immune globulin (privigen), intravenous…, 3 articles); J1557 (Injection, immune globulin, (gammaplex), intravenous…, 3 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list L51.3?
A56786 (Billing and Coding: Immune Globulin); A57778 (Billing and Coding: Immune Globulin); A57554 (Billing and Coding: Immune Globulins).
What is ICD-10-CM code L51.3?
L51.3 is the ICD-10-CM code for stevens-Johnson syndrome-toxic epidermal necrolysis overlap syndrome, in category L51 (Erythema multiforme), chapter 12: Diseases of the skin and subcutaneous tissue.
Next steps
- Run a reimbursement report for a device billed under J1575
- Watch J1575 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1575
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