N30.11: Interstitial cystitis (chronic) with hematuria
N30.11, interstitial cystitis (chronic) with hematuria, is listed as a covered diagnosis in 9 Medicare billing and coding articles that apply to 13 HCPCS Level II codes, including A4290 (Sacral nerve stimulation test lead, each), C1767 (Generator, neurostimulator (implantable), non-rechargeable), C1778 (Lead, neurostimulator (implantable)). 1 of these codes has a 2026 DMEPOS fee schedule amount; L8678 pays $11.40 to $31.64 depending on the state. 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 N30.11 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| A4290 | Sacral nerve stimulation test lead, each | Carrier judgment | — | 3 |
| C1767 | Generator, neurostimulator (implantable), non-rechargeable | Special coverage instructions apply | — | 3 |
| C1778 | Lead, neurostimulator (implantable) | Special coverage instructions apply | — | 3 |
| C1883 | Adapter/extension, pacing lead or neurostimulator lead (implantable) | Special coverage instructions apply | — | 3 |
| C1897 | Lead, neurostimulator test kit (implantable) | Special coverage instructions apply | — | 3 |
| J0585 | Injection, onabotulinumtoxina, 1 unit | Special coverage instructions apply | — | 6 |
| J0588 | Injection, incobotulinumtoxin a, 1 unit | Carrier judgment | — | 6 |
| J0586 | Injection, abobotulinumtoxina, 5 units | Carrier judgment | — | 6 |
| J0587 | Injection, rimabotulinumtoxinb, 100 units | Special coverage instructions apply | — | 6 |
| J0589 | Injection, daxibotulinumtoxina-lanm, 1 unit | Carrier judgment | — | 6 |
| C1820 | Generator, neurostimulator (implantable), with rechargeable battery and charging system | Special coverage instructions apply | — | 2 |
| L8678 | Electrical stimulator supplies (external) for use with implantable neurostimulator, per month | Carrier judgment | $11.40–$31.64 | 1 |
| L8680 | Implantable neurostimulator electrode, each | Not payable by Medicare | Not covered | 2 |
Medicare policy articles listing N30.11
- A55835: Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 6 Level II codes)
- A53359: Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 7 Level II codes)
- A59332: Billing and Coding: Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence (Palmetto GBA (MAC - Part A, MAC - Part B); 7 Level II codes). LCD with the same title: L39543
- A57185: Billing and Coding: Botulinum Toxin Injections (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35170, L35172, L39832, L39836
- A57186: Billing and Coding: Botulinum Toxin Injections (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35170, L35172, L39832, L39836
- A59707: Billing and Coding: Botulinum Toxin Injections (Wellpoint Federal (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35170, L35172, L39832, L39836
- A59714: Billing and Coding: Botulinum Toxin Injections (Palmetto GBA (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35170, L35172, L39832, L39836
- A59726: Billing and Coding: Botulinum Toxins Injections (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 5 Level II codes)
- A59809: Billing and Coding: Botulinum Toxin Injections (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35170, L35172, L39832, L39836
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 N30 diagnoses (Cystitis)
- N30.10 — Interstitial cystitis (chronic) without hematuria
Frequently asked questions
Does Medicare cover N30.11 (Interstitial cystitis (chronic) with hematuria)?
Medicare covers items and services, not diagnoses. 9 Medicare billing and coding articles list N30.11 as a covered diagnosis for 13 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 N30.11?
The Level II codes from the policies most specific to this diagnosis are A4290 (Sacral nerve stimulation test lead, each, 3 articles); C1767 (Generator, neurostimulator (implantable), non-rechargeable, 3 articles); C1778 (Lead, neurostimulator (implantable), 3 articles); C1883 (Adapter/extension, pacing lead or neurostimulator lead…, 3 articles); C1897 (Lead, neurostimulator test kit (implantable), 3 articles). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with N30.11?
Under the 2026 DMEPOS fee schedule (non-rural state fees): L8678 $11.40 to $31.64. Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list N30.11?
A55835 (Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence); A53359 (Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence); A59332 (Billing and Coding: Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence), and 6 more articles.
What is ICD-10-CM code N30.11?
N30.11 is the ICD-10-CM code for interstitial cystitis (chronic) with hematuria, in category N30 (Cystitis), chapter 14: Diseases of the genitourinary system.
Next steps
- Run a reimbursement report for a device billed under A4290
- Watch A4290 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4290
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