N04.0: Nephrotic syndrome with minor glomerular abnormality
N04.0, nephrotic syndrome with minor glomerular abnormality, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 8 HCPCS Level II codes, including J9312 (Injection, rituximab, 10 mg), Q5119 (Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg), Q5115 (Injection, rituximab-abbs, biosimilar, (truxima), 10 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 N04.0 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J9312 | Injection, rituximab, 10 mg | Special coverage instructions apply | — | 4 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | Carrier judgment | — | 4 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | Special coverage instructions apply | — | 4 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | Carrier judgment | — | 3 |
| 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 |
| J9311 | Injection, rituximab 10 mg and hyaluronidase | Special coverage instructions apply | — | 1 |
| J3590 | Unclassified biologics | Carrier judgment | — | 1 |
Medicare policy articles listing N04.0
- A58582: Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L38920, L39297
- A55639: Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 6 Level II codes)
- A56380: Billing and Coding: Rituximab (Palmetto GBA (MAC - Part A, MAC - Part B); 6 Level II codes). LCD with the same title: L35026
- 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.
Frequently asked questions
Does Medicare cover N04.0 (Nephrotic syndrome with minor glomerular abnormality)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list N04.0 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 N04.0?
The Level II codes from the policies most specific to this diagnosis are J9312 (Injection, rituximab, 10 mg, 4 articles); Q5119 (Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg, 4 articles); Q5115 (Injection, rituximab-abbs, biosimilar, (truxima), 10 mg, 4 articles); Q5123 (Injection, rituximab-arrx, biosimilar, (riabni), 10 mg, 3 articles); J9260 (Injection, methotrexate sodium, 50 mg, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list N04.0?
A58582 (Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars); A55639 (Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions); A56380 (Billing and Coding: Rituximab), and 1 more article.
What is ICD-10-CM code N04.0?
N04.0 is the ICD-10-CM code for nephrotic syndrome with minor glomerular abnormality, in category N04 (Nephrotic syndrome), chapter 14: Diseases of the genitourinary system.
Next steps
- Run a reimbursement report for a device billed under J9312
- Watch J9312 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9312
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 14: Diseases of the genitourinary system · All diagnoses · HCPCS lookup