S91.204A: Unspecified open wound of right lesser toe(s) with damage to nail, initial encounter

S91.204A, unspecified open wound of right lesser toe(s) with damage to nail, initial encounter, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 36 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 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 S91.204A as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
J1575Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulinCarrier judgment—1
J1569Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mgSpecial coverage instructions apply—1
J1561Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mgSpecial coverage instructions apply—1
J1459Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—1
J1557Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—1
J1556Injection, immune globulin (bivigam), 500 mgCarrier judgment—1
J1568Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—1
J1566Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mgSpecial coverage instructions apply—1
J1554Injection, immune globulin (asceniv), 500 mgCarrier judgment—1
J1599Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mgCarrier judgment—1
J1572Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mgSpecial coverage instructions apply—1
J1460Injection, gamma globulin, intramuscular, 1 ccSpecial coverage instructions apply—1
J1670Injection, tetanus immune globulin, human, up to 250 unitsSpecial coverage instructions apply—1
J0840Injection, crotalidae polyvalent immune fab (ovine), up to 1 gramCarrier judgment—1
J0850Injection, cytomegalovirus immune globulin intravenous (human), per vialSpecial coverage instructions apply—1
J1552Injection, immune globulin (alyglo), 500 mgCarrier judgment—1
J1560Injection, gamma globulin, intramuscular, over 10 ccSpecial coverage instructions apply—1
J1571Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 mlSpecial coverage instructions apply—1
J1573Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 mlCarrier judgment—1
J1577Injection, immune globulin (qivigy), 100 mgCarrier 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
Q2035Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)Special coverage instructions apply—1

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

Medicare policy articles listing S91.204A

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 S91 diagnoses (Open wound of ankle, foot and toes)

Frequently asked questions

Does Medicare cover S91.204A (Unspecified open wound of right lesser toe(s) with damage…)?

Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list S91.204A as a covered diagnosis for 36 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 S91.204A?

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 S91.204A?

A57554 (Billing and Coding: Immune Globulins); A54767 (Billing and Coding: Medicare Preventive Coverage for Certain Vaccines); A57311 (Billing and Coding: Physical Therapy - Home Health).

What is ICD-10-CM code S91.204A?

S91.204A is the ICD-10-CM code for unspecified open wound of right lesser toe(s) with damage to nail, initial encounter, in category S91 (Open wound of ankle, foot and toes), 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