S81.801A: Unspecified open wound, right lower leg, initial encounter
S81.801A, unspecified open wound, right lower leg, initial encounter, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 35 HCPCS Level II codes, including J1575 (Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg…), J1569 (Injection, immune globulin, (gammagard liquid/gammagard…), J1561 (Injection, immune globulin, (gamunex-c/gammaked)…). The articles come from 2 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 S81.801A as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J1575 | Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin | Carrier judgment | — | 1 |
| J1569 | Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mg | Special coverage instructions apply | — | 1 |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 1 |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1557 | Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1556 | Injection, immune globulin (bivigam), 500 mg | Carrier judgment | — | 1 |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg | Special coverage instructions apply | — | 1 |
| J1554 | Injection, immune globulin (asceniv), 500 mg | Carrier judgment | — | 1 |
| J1599 | Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg | Carrier judgment | — | 1 |
| J1572 | Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 1 |
| J1460 | Injection, gamma globulin, intramuscular, 1 cc | Special coverage instructions apply | — | 1 |
| J1670 | Injection, tetanus immune globulin, human, up to 250 units | Special coverage instructions apply | — | 1 |
| J0840 | Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram | Carrier judgment | — | 1 |
| J0850 | Injection, cytomegalovirus immune globulin intravenous (human), per vial | Special coverage instructions apply | — | 1 |
| J1552 | Injection, immune globulin (alyglo), 500 mg | Carrier judgment | — | 1 |
| J1560 | Injection, gamma globulin, intramuscular, over 10 cc | Special coverage instructions apply | — | 1 |
| J1571 | Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml | Special coverage instructions apply | — | 1 |
| J1573 | Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml | Carrier judgment | — | 1 |
| J1577 | Injection, immune globulin (qivigy), 100 mg | Carrier judgment | — | 1 |
| G0008 | Administration of influenza virus vaccine | Carrier judgment | — | 1 |
| G0009 | Administration of pneumococcal vaccine | Carrier judgment | — | 1 |
| G0010 | Administration of hepatitis b vaccine | Carrier judgment | — | 1 |
| Q2038 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) | Special coverage instructions apply | — | 1 |
| Q2035 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) | Special coverage instructions apply | — | 1 |
10 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing S81.801A
- A57554: Billing and Coding: Immune Globulins (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 20 Level II codes). LCD with the same title: L34771
- A54767: Billing and Coding: Medicare Preventive Coverage for Certain Vaccines (Palmetto GBA (MAC - Part A, MAC - Part B); 9 Level II codes)
- A53058: Billing and Coding: Home Health Physical Therapy (Palmetto GBA (HHH MAC); 6 Level II codes). LCD with the same title: L34564
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 S81 diagnoses (Open wound of knee and lower leg)
- S81.802A — Unspecified open wound, left lower leg, initial encounter
- S81.811A — Laceration without foreign body, right lower leg, initial encounter
- S81.812A — Laceration without foreign body, left lower leg, initial encounter
- S81.821A — Laceration with foreign body, right lower leg, initial encounter
- S81.822A — Laceration with foreign body, left lower leg, initial encounter
- S81.831A — Puncture wound without foreign body, right lower leg, initial…
- S81.832A — Puncture wound without foreign body, left lower leg, initial encounter
- S81.841A — Puncture wound with foreign body, right lower leg, initial encounter
- S81.842A — Puncture wound with foreign body, left lower leg, initial encounter
- S81.851A — Open bite, right lower leg, initial encounter
- S81.852A — Open bite, left lower leg, initial encounter
- S81.001A — Unspecified open wound, right knee, initial encounter
- S81.002A — Unspecified open wound, left knee, initial encounter
- S81.011A — Laceration without foreign body, right knee, initial encounter
- S81.012A — Laceration without foreign body, left knee, initial encounter
- S81.021A — Laceration with foreign body, right knee, initial encounter
- S81.022A — Laceration with foreign body, left knee, initial encounter
- S81.031A — Puncture wound without foreign body, right knee, initial encounter
- S81.032A — Puncture wound without foreign body, left knee, initial encounter
- S81.041A — Puncture wound with foreign body, right knee, initial encounter
- S81.042A — Puncture wound with foreign body, left knee, initial encounter
- S81.051A — Open bite, right knee, initial encounter
- S81.052A — Open bite, left knee, initial encounter
Frequently asked questions
Does Medicare cover S81.801A (Unspecified open wound, right lower leg, initial encounter)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list S81.801A as a covered diagnosis for 35 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 S81.801A?
The Level II codes from the policies most specific to this diagnosis are J1575 (Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg…, 1 article); J1569 (Injection, immune globulin, (gammagard liquid/gammagard…, 1 article); J1561 (Injection, immune globulin, (gamunex-c/gammaked)…, 1 article); J1459 (Injection, immune globulin (privigen), intravenous…, 1 article); J1557 (Injection, immune globulin, (gammaplex), intravenous…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list S81.801A?
A57554 (Billing and Coding: Immune Globulins); A54767 (Billing and Coding: Medicare Preventive Coverage for Certain Vaccines); A53058 (Billing and Coding: Home Health Physical Therapy).
What is ICD-10-CM code S81.801A?
S81.801A is the ICD-10-CM code for unspecified open wound, right lower leg, initial encounter, in category S81 (Open wound of knee and lower leg), chapter 19: Injury, poisoning and other consequences of external causes.
Next steps
- Run a reimbursement report for a device billed under J1575
- Watch J1575 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1575
Compiled by Caduvo from public CMS (Medicare) records, ICD-10-CM FY2026, HCPCS release October 2026, 2026 fee schedule (non-rural state fees). Not reviewed or endorsed by CMS. Not billing or legal advice. Report an error. Data and corrections policy.
Chapter 19: Injury, poisoning and other consequences of external causes · All diagnoses · HCPCS lookup