Q21.8: Other congenital malformations of cardiac septa
Q21.8, other congenital malformations of cardiac septa, is listed as a covered diagnosis in 7 Medicare billing and coding articles that apply to 32 HCPCS Level II codes, including J0153 (Injection, adenosine, 1 mg (not to be used to report any…), J1250 (Injection, dobutamine hydrochloride, per 250 mg), J1245 (Injection, dipyridamole, per 10 mg). 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 Q21.8 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J0153 | Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) | Special coverage instructions apply | — | 5 |
| J1250 | Injection, dobutamine hydrochloride, per 250 mg | Special coverage instructions apply | — | 5 |
| J1245 | Injection, dipyridamole, per 10 mg | Special coverage instructions apply | — | 5 |
| J0461 | Injection, atropine sulfate, 0.01 mg | Special coverage instructions apply | — | 4 |
| J0280 | Injection, aminophyllin, up to 250 mg | Special coverage instructions apply | — | 4 |
| A9700 | Supply of injectable contrast material for use in echocardiography, per study | Special coverage instructions apply | — | 3 |
| J3490 | Unclassified drugs | Special coverage instructions apply | — | 2 |
| J2785 | Injection, regadenoson, 0.1 mg | Carrier judgment | — | 2 |
| Q9957 | Injection, perflutren lipid microspheres, per ml | Carrier judgment | — | 2 |
| Q9956 | Injection, octafluoropropane microspheres, per ml | Carrier judgment | — | 2 |
| C8921 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete | Special coverage instructions apply | — | 2 |
| C8922 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited study | Special coverage instructions apply | — | 2 |
| C8923 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, without spectral or color doppler echocardiography | Special coverage instructions apply | — | 2 |
| C8924 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study | Special coverage instructions apply | — | 2 |
| C8928 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report | Special coverage instructions apply | — | 2 |
| C8929 | Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography | Special coverage instructions apply | — | 2 |
| C8930 | Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision | Special coverage instructions apply | — | 2 |
| Q9955 | Injection, perflexane lipid microspheres, per ml | Carrier judgment | — | 2 |
| C8925 | Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, real time with image documentation (2d) (with or without m-mode recording); including probe placement, image acquisition, interpretation and report | Special coverage instructions apply | — | 1 |
| C8926 | Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report | Special coverage instructions apply | — | 1 |
| C8927 | Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis | Special coverage instructions apply | — | 1 |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | Carrier judgment | — | 1 |
| A9502 | Technetium tc-99m tetrofosmin, diagnostic, per study dose | Carrier judgment | — | 1 |
| A9555 | Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries | Carrier judgment | — | 1 |
| A9505 | Thallium tl-201 thallous chloride, diagnostic, per millicurie | Carrier judgment | — | 1 |
7 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing Q21.8
- A57179: Billing and Coding: Transesophageal Echocardiogram (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L33756
- A57183: Billing and Coding: Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 4 Level II codes). LCD with the same title: L34324
- A56476: Billing and Coding: Cardiac Radionuclide Imaging (Palmetto GBA (MAC - Part A, MAC - Part B); 13 Level II codes). LCD with the same title: L33457
- A52850: Billing and Coding: Cardiac Catheterization and Coronary Angiography (Wellpoint Federal (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L33557, L33959
- A57306: Billing and Coding: Transthoracic Echocardiography (TTE) (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 19 Level II codes). LCD with the same title: L33577, L34338
- A56781: Billing and Coding: Transthoracic Echocardiography (TTE) (Wellpoint Federal (MAC - Part A, MAC - Part B); 17 Level II codes). LCD with the same title: L33577, L34338
- A56625: Billing and Coding: Echocardiography (Palmetto GBA (MAC - Part A, MAC - Part B); 6 Level II codes). LCD with the same title: L37379
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 Q21 diagnoses (Congenital malformations of cardiac septa)
- Q21.0 — Ventricular septal defect
- Q21.10 — Atrial septal defect, unspecified
- Q21.11 — Secundum atrial septal defect
- Q21.12 — Patent foramen ovale
- Q21.13 — Coronary sinus atrial septal defect
- Q21.14 — Superior sinus venosus atrial septal defect
- Q21.15 — Inferior sinus venosus atrial septal defect
- Q21.16 — Sinus venosus atrial septal defect, unspecified
- Q21.19 — Other specified atrial septal defect
- Q21.20 — Atrioventricular septal defect, unspecified as to partial or complete
- Q21.21 — Partial atrioventricular septal defect
- Q21.22 — Transitional atrioventricular septal defect
- Q21.23 — Complete atrioventricular septal defect
- Q21.3 — Tetralogy of Fallot
- Q21.4 — Aortopulmonary septal defect
- Q21.9 — Congenital malformation of cardiac septum, unspecified
Frequently asked questions
Does Medicare cover Q21.8 (Other congenital malformations of cardiac septa)?
Medicare covers items and services, not diagnoses. 7 Medicare billing and coding articles list Q21.8 as a covered diagnosis for 32 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 Q21.8?
The Level II codes from the policies most specific to this diagnosis are J0153 (Injection, adenosine, 1 mg (not to be used to report any…, 5 articles); J1250 (Injection, dobutamine hydrochloride, per 250 mg, 5 articles); J1245 (Injection, dipyridamole, per 10 mg, 5 articles); J0461 (Injection, atropine sulfate, 0.01 mg, 4 articles); J0280 (Injection, aminophyllin, up to 250 mg, 4 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list Q21.8?
A57179 (Billing and Coding: Transesophageal Echocardiogram); A57183 (Billing and Coding: Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography); A56476 (Billing and Coding: Cardiac Radionuclide Imaging), and 4 more articles.
What is ICD-10-CM code Q21.8?
Q21.8 is the ICD-10-CM code for other congenital malformations of cardiac septa, in category Q21 (Congenital malformations of cardiac septa), chapter 17: Congenital malformations and chromosomal abnormalities.
Next steps
- Run a reimbursement report for a device billed under J0153
- Watch J0153 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0153
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