Q40.1: Congenital hiatus hernia

Q40.1, congenital hiatus hernia, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 20 HCPCS Level II codes, including J2785 (Injection, regadenoson, 0.1 mg), J0461 (Injection, atropine sulfate, 0.01 mg), J0153 (Injection, adenosine, 1 mg (not to be used to report any…). 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 Q40.1 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
J2785Injection, regadenoson, 0.1 mgCarrier judgment—2
J0461Injection, atropine sulfate, 0.01 mgSpecial coverage instructions apply—2
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)Special coverage instructions apply—2
Q9957Injection, perflutren lipid microspheres, per mlCarrier judgment—2
J1250Injection, dobutamine hydrochloride, per 250 mgSpecial coverage instructions apply—2
J0280Injection, aminophyllin, up to 250 mgSpecial coverage instructions apply—2
J1245Injection, dipyridamole, per 10 mgSpecial coverage instructions apply—2
Q9956Injection, octafluoropropane microspheres, per mlCarrier judgment—2
A9700Supply of injectable contrast material for use in echocardiography, per studySpecial coverage instructions apply—2
C8921Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; completeSpecial coverage instructions apply—2
C8922Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited studySpecial coverage instructions apply—2
C8923Transthoracic 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 echocardiographySpecial coverage instructions apply—2
C8924Transthoracic 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 studySpecial coverage instructions apply—2
C8928Transthoracic 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 reportSpecial coverage instructions apply—2
C8929Transthoracic 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 echocardiographySpecial coverage instructions apply—2
C8930Transthoracic 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 supervisionSpecial coverage instructions apply—2
Q9955Injection, perflexane lipid microspheres, per mlCarrier judgment—2
J0585Injection, onabotulinumtoxina, 1 unitSpecial coverage instructions apply—1
J3490Unclassified drugsSpecial coverage instructions apply—1
C9399Unclassified drugs or biologicalsSpecial coverage instructions apply—1

Medicare policy articles listing Q40.1

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 Q40.1 (Congenital hiatus hernia)?

Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list Q40.1 as a covered diagnosis for 20 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 Q40.1?

The Level II codes from the policies most specific to this diagnosis are J2785 (Injection, regadenoson, 0.1 mg, 2 articles); J0461 (Injection, atropine sulfate, 0.01 mg, 2 articles); J0153 (Injection, adenosine, 1 mg (not to be used to report any…, 2 articles); Q9957 (Injection, perflutren lipid microspheres, per ml, 2 articles); J1250 (Injection, dobutamine hydrochloride, per 250 mg, 2 articles). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list Q40.1?

A56389 (Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization); A57306 (Billing and Coding: Transthoracic Echocardiography (TTE)); A56781 (Billing and Coding: Transthoracic Echocardiography (TTE)).

What is ICD-10-CM code Q40.1?

Q40.1 is the ICD-10-CM code for congenital hiatus hernia, in category Q40 (Other congenital malformations of upper alimentary tract), chapter 17: Congenital malformations and chromosomal abnormalities.

Next steps

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