T85.42XA: Displacement of breast prosthesis and implant, initial encounter

T85.42XA, displacement of breast prosthesis and implant, initial encounter, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 8 HCPCS Level II codes, including C8903 (Magnetic resonance imaging with contrast, breast; unilateral), C8905 (Magnetic resonance imaging without contrast followed by…), C8906 (Magnetic resonance imaging with contrast, breast; bilateral). 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 T85.42XA as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
C8903Magnetic resonance imaging with contrast, breast; unilateralSpecial coverage instructions apply—2
C8905Magnetic resonance imaging without contrast followed by with contrast, breast; unilateralSpecial coverage instructions apply—2
C8906Magnetic resonance imaging with contrast, breast; bilateralSpecial coverage instructions apply—2
C8908Magnetic resonance imaging without contrast followed by with contrast, breast; bilateralSpecial coverage instructions apply—2
Q2028Injection, sculptra, 0.5 mgSpecial coverage instructions apply—2
G0429Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)Carrier judgment—2
Q2026Injection, radiesse, 0.1 mlSpecial coverage instructions apply—2
G0279Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)Carrier judgment—1

Medicare policy articles listing T85.42XA

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 T85.42XA (Displacement of breast prosthesis and implant, initial…)?

Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list T85.42XA as a covered diagnosis for 8 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 T85.42XA?

The Level II codes from the policies most specific to this diagnosis are C8903 (Magnetic resonance imaging with contrast, breast; unilateral, 2 articles); C8905 (Magnetic resonance imaging without contrast followed by…, 2 articles); C8906 (Magnetic resonance imaging with contrast, breast; bilateral, 2 articles); C8908 (Magnetic resonance imaging without contrast followed by…, 2 articles); Q2028 (Injection, sculptra, 0.5 mg, 2 articles). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list T85.42XA?

A52849 (Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography); A56448 (Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography); A59299 (Billing and Coding: Cosmetic and Reconstructive Surgery), and 1 more article.

What is ICD-10-CM code T85.42XA?

T85.42XA is the ICD-10-CM code for displacement of breast prosthesis and implant, 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