T85.111A: Breakdown (mechanical) of implanted electronic neurostimulator of peripheral nerve electrode (lead), initial encounter

T85.111A, breakdown (mechanical) of implanted electronic neurostimulator of peripheral nerve electrode (lead), initial encounter, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 26 HCPCS Level II codes, including A4290 (Sacral nerve stimulation test lead, each), C1767 (Generator, neurostimulator (implantable), non-rechargeable), C1778 (Lead, neurostimulator (implantable)). 1 of these codes has a 2026 DMEPOS fee schedule amount; L8678 pays $11.40 to $31.64 depending on the state. 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 T85.111A as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
A4290Sacral nerve stimulation test lead, eachCarrier judgment—2
C1767Generator, neurostimulator (implantable), non-rechargeableSpecial coverage instructions apply—2
C1778Lead, neurostimulator (implantable)Special coverage instructions apply—2
C1820Generator, neurostimulator (implantable), with rechargeable battery and charging systemSpecial coverage instructions apply—2
C1883Adapter/extension, pacing lead or neurostimulator lead (implantable)Special coverage instructions apply—2
C1897Lead, neurostimulator test kit (implantable)Special coverage instructions apply—2
L8678Electrical stimulator supplies (external) for use with implantable neurostimulator, per monthCarrier judgment$11.40–$31.641
C8900Magnetic resonance angiography with contrast, abdomenSpecial coverage instructions apply—1
C8901Magnetic resonance angiography without contrast, abdomenSpecial coverage instructions apply—1
C8902Magnetic resonance angiography without contrast followed by with contrast, abdomenSpecial coverage instructions apply—1
C8909Magnetic resonance angiography with contrast, chest (excluding myocardium)Special coverage instructions apply—1
C8910Magnetic resonance angiography without contrast, chest (excluding myocardium)Special coverage instructions apply—1
C8911Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)Special coverage instructions apply—1
C8912Magnetic resonance angiography with contrast, lower extremitySpecial coverage instructions apply—1
C8913Magnetic resonance angiography without contrast, lower extremitySpecial coverage instructions apply—1
C8914Magnetic resonance angiography without contrast followed by with contrast, lower extremitySpecial coverage instructions apply—1
C8918Magnetic resonance angiography with contrast, pelvisSpecial coverage instructions apply—1
C8919Magnetic resonance angiography without contrast, pelvisSpecial coverage instructions apply—1
C8920Magnetic resonance angiography without contrast followed by with contrast, pelvisSpecial coverage instructions apply—1
C8931Magnetic resonance angiography with contrast, spinal canal and contentsSpecial coverage instructions apply—1
C8932Magnetic resonance angiography without contrast, spinal canal and contentsSpecial coverage instructions apply—1
C8933Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contentsSpecial coverage instructions apply—1
C8934Magnetic resonance angiography with contrast, upper extremitySpecial coverage instructions apply—1
C8935Magnetic resonance angiography without contrast, upper extremitySpecial coverage instructions apply—1
C8936Magnetic resonance angiography without contrast followed by with contrast, upper extremitySpecial coverage instructions apply—1

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

Medicare policy articles listing T85.111A

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 T85 diagnoses (Complications of other internal prosthetic devices, implants and grafts)

Frequently asked questions

Does Medicare cover T85.111A (Breakdown (mechanical) of implanted electronic…)?

Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list T85.111A as a covered diagnosis for 26 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 T85.111A?

The Level II codes from the policies most specific to this diagnosis are A4290 (Sacral nerve stimulation test lead, each, 2 articles); C1767 (Generator, neurostimulator (implantable), non-rechargeable, 2 articles); C1778 (Lead, neurostimulator (implantable), 2 articles); C1820 (Generator, neurostimulator (implantable), with…, 2 articles); C1883 (Adapter/extension, pacing lead or neurostimulator lead…, 2 articles). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with T85.111A?

Under the 2026 DMEPOS fee schedule (non-rural state fees): L8678 $11.40 to $31.64. Medicare pays 80% of the allowed amount after the Part B deductible.

Which Medicare policy articles list T85.111A?

A53359 (Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence); A59332 (Billing and Coding: Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence); A56747 (Billing and Coding: Magnetic Resonance Angiography (MRA)).

What is ICD-10-CM code T85.111A?

T85.111A is the ICD-10-CM code for breakdown (mechanical) of implanted electronic neurostimulator of peripheral nerve electrode (lead), initial encounter, in category T85 (Complications of other internal prosthetic devices, implants and grafts), 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