S12.001B: Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for open fracture

S12.001B, unspecified nondisplaced fracture of first cervical vertebra, initial encounter for open fracture, is listed as a covered diagnosis in 5 Medicare billing and coding articles that apply to 30 HCPCS Level II codes, including G0130 (Single energy x-ray absorptiometry (sexa) bone density…), G0453 (Continuous intraoperative neurophysiology monitoring, from…), J2785 (Injection, regadenoson, 0.1 mg). 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 S12.001B as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
G0130Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)Special coverage instructions apply—2
G0453Continuous 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—1
J2785Injection, regadenoson, 0.1 mgCarrier judgment—1
J0461Injection, atropine sulfate, 0.01 mgSpecial coverage instructions apply—1
J3490Unclassified drugsSpecial coverage instructions apply—1
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)Special coverage instructions apply—1
Q9957Injection, perflutren lipid microspheres, per mlCarrier judgment—1
J1250Injection, dobutamine hydrochloride, per 250 mgSpecial coverage instructions apply—1
J0280Injection, aminophyllin, up to 250 mgSpecial coverage instructions apply—1
J1245Injection, dipyridamole, per 10 mgSpecial coverage instructions apply—1
Q9956Injection, octafluoropropane microspheres, per mlCarrier judgment—1
C9399Unclassified drugs or biologicalsSpecial coverage instructions apply—1
A9700Supply of injectable contrast material for use in echocardiography, per studySpecial coverage instructions apply—1
C8921Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; completeSpecial coverage instructions apply—1
C8922Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited studySpecial coverage instructions apply—1
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—1
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—1
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—1
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—1
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—1
Q9955Injection, perflexane lipid microspheres, per mlCarrier judgment—1
G0008Administration of influenza virus vaccineCarrier judgment—1
G0009Administration of pneumococcal vaccineCarrier judgment—1
G0010Administration of hepatitis b vaccineCarrier judgment—1
Q2038Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)Special coverage instructions apply—1

5 more codes are listed. See every code with payment by region in Caduvo.

Medicare policy articles listing S12.001B

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 S12 diagnoses (Fracture of cervical vertebra and other parts of neck)

Frequently asked questions

Does Medicare cover S12.001B (Unspecified nondisplaced fracture of first cervical…)?

Medicare covers items and services, not diagnoses. 5 Medicare billing and coding articles list S12.001B as a covered diagnosis for 30 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 S12.001B?

The Level II codes from the policies most specific to this diagnosis are G0130 (Single energy x-ray absorptiometry (sexa) bone density…, 2 articles); G0453 (Continuous intraoperative neurophysiology monitoring, from…, 1 article); J2785 (Injection, regadenoson, 0.1 mg, 1 article); J0461 (Injection, atropine sulfate, 0.01 mg, 1 article); J3490 (Unclassified drugs, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list S12.001B?

A59040 (Billing and Coding: Bone Mass Measurement); A57132 (Billing and Coding: Bone Mass Measurement); A56722 (Billing and Coding: Intraoperative Neurophysiological Testing), and 2 more articles.

What is ICD-10-CM code S12.001B?

S12.001B is the ICD-10-CM code for unspecified nondisplaced fracture of first cervical vertebra, initial encounter for open fracture, in category S12 (Fracture of cervical vertebra and other parts of neck), chapter 19: Injury, poisoning and other consequences of external causes.

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 19: Injury, poisoning and other consequences of external causes · All diagnoses · HCPCS lookup