P11.5: Birth injury to spine and spinal cord
P11.5, birth injury to spine and spinal cord, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 3 HCPCS Level II codes, including G0453 (Continuous intraoperative neurophysiology monitoring, from…), A9585 (Injection, gadobutrol, 0.1 ml), Q9953 (Injection, iron-based magnetic resonance contrast agent…). 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 P11.5 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G0453 | Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure) | Carrier judgment | — | 2 |
| A9585 | Injection, gadobutrol, 0.1 ml | Carrier judgment | — | 1 |
| Q9953 | Injection, iron-based magnetic resonance contrast agent, per ml | Special coverage instructions apply | — | 1 |
Medicare policy articles listing P11.5
- A57604: Billing and Coding: Intraoperative Neurophysiological Testing (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34623, L35003
- A56722: Billing and Coding: Intraoperative Neurophysiological Testing (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34623, L35003
- A57206: Billing and Coding: Lumbar MRI (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L34220
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 P11.5 (Birth injury to spine and spinal cord)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list P11.5 as a covered diagnosis for 3 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 P11.5?
The Level II codes from the policies most specific to this diagnosis are G0453 (Continuous intraoperative neurophysiology monitoring, from…, 2 articles); A9585 (Injection, gadobutrol, 0.1 ml, 1 article); Q9953 (Injection, iron-based magnetic resonance contrast agent…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list P11.5?
A57604 (Billing and Coding: Intraoperative Neurophysiological Testing); A56722 (Billing and Coding: Intraoperative Neurophysiological Testing); A57206 (Billing and Coding: Lumbar MRI).
What is ICD-10-CM code P11.5?
P11.5 is the ICD-10-CM code for birth injury to spine and spinal cord, in category P11 (Other birth injuries to central nervous system), chapter 16: Certain conditions originating in the perinatal period.
Next steps
- Run a reimbursement report for a device billed under G0453
- Watch G0453 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0453
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 16: Certain conditions originating in the perinatal period · All diagnoses · HCPCS lookup