Q05.1: Thoracic spina bifida with hydrocephalus
Q05.1, thoracic spina bifida with hydrocephalus, is listed as a covered diagnosis in 7 Medicare billing and coding articles that apply to 2 HCPCS Level II codes, including G0453 (Continuous intraoperative neurophysiology monitoring, from…), G0255 (Current perception threshold/sensory nerve conduction…). The articles come from 6 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 Q05.1 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 |
| G0255 | Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve | Non-covered by Medicare | Not covered | 5 |
Medicare policy articles listing Q05.1
- 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
- A57307: Billing and Coding: Nerve Conduction Studies and Electromyography (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A57478: Billing and Coding: Nerve Conduction Studies and Electromyography (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A54969: Billing and Coding: Nerve Conduction Studies and Electromyography (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A57668: Billing and Coding: Nerve Conduction Studies and Electromyography (Wellpoint Federal (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A56619: Billing and Coding: Nerve Conduction Studies and Electromyography (Palmetto GBA (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
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 Q05 diagnoses (Spina bifida)
- Q05.0 — Cervical spina bifida with hydrocephalus
- Q05.2 — Lumbar spina bifida with hydrocephalus
- Q05.3 — Sacral spina bifida with hydrocephalus
- Q05.5 — Cervical spina bifida without hydrocephalus
- Q05.6 — Thoracic spina bifida without hydrocephalus
- Q05.7 — Lumbar spina bifida without hydrocephalus
- Q05.8 — Sacral spina bifida without hydrocephalus
Frequently asked questions
Does Medicare cover Q05.1 (Thoracic spina bifida with hydrocephalus)?
Medicare covers items and services, not diagnoses. 7 Medicare billing and coding articles list Q05.1 as a covered diagnosis for 2 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 Q05.1?
The Level II codes from the policies most specific to this diagnosis are G0453 (Continuous intraoperative neurophysiology monitoring, from…, 2 articles); G0255 (Current perception threshold/sensory nerve conduction…, 5 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list Q05.1?
A57604 (Billing and Coding: Intraoperative Neurophysiological Testing); A56722 (Billing and Coding: Intraoperative Neurophysiological Testing); A57307 (Billing and Coding: Nerve Conduction Studies and Electromyography), and 4 more articles.
What is ICD-10-CM code Q05.1?
Q05.1 is the ICD-10-CM code for thoracic spina bifida with hydrocephalus, in category Q05 (Spina bifida), chapter 17: Congenital malformations and chromosomal abnormalities.
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 17: Congenital malformations and chromosomal abnormalities · All diagnoses · HCPCS lookup