T85.79XA: Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter

T85.79XA, infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter, is listed as a covered diagnosis in 8 Medicare billing and coding articles that apply to 31 HCPCS Level II codes, including Q2028 (Injection, sculptra, 0.5 mg), G0429 (Dermal filler injection(s) for the treatment of facial…), Q2026 (Injection, radiesse, 0.1 ml). The articles come from 4 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 T85.79XA as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
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
C8903Magnetic resonance imaging with contrast, breast; unilateralSpecial coverage instructions apply—1
C8905Magnetic resonance imaging without contrast followed by with contrast, breast; unilateralSpecial coverage instructions apply—1
C8906Magnetic resonance imaging with contrast, breast; bilateralSpecial coverage instructions apply—1
C8908Magnetic resonance imaging without contrast followed by with contrast, breast; bilateralSpecial coverage instructions apply—1
C8925Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, real time with image documentation (2d) (with or without m-mode recording); including probe placement, image acquisition, interpretation and reportSpecial coverage instructions apply—2
C8926Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and reportSpecial coverage instructions apply—2
C8927Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basisSpecial coverage instructions apply—2
J2785Injection, regadenoson, 0.1 mgCarrier judgment—2
J0461Injection, atropine sulfate, 0.01 mgSpecial coverage instructions apply—2
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)Special coverage instructions apply—2
Q9957Injection, perflutren lipid microspheres, per mlCarrier judgment—2
J1250Injection, dobutamine hydrochloride, per 250 mgSpecial coverage instructions apply—2
J0280Injection, aminophyllin, up to 250 mgSpecial coverage instructions apply—2
J1245Injection, dipyridamole, per 10 mgSpecial coverage instructions apply—2
Q9956Injection, octafluoropropane microspheres, per mlCarrier judgment—2
A9700Supply of injectable contrast material for use in echocardiography, per studySpecial coverage instructions apply—2
C8921Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; completeSpecial coverage instructions apply—2
C8922Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited studySpecial coverage instructions apply—2
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—2
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—2
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—2
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—2

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

Medicare policy articles listing T85.79XA

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 T85.79XA (Infection and inflammatory reaction due to other internal…)?

Medicare covers items and services, not diagnoses. 8 Medicare billing and coding articles list T85.79XA as a covered diagnosis for 31 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 T85.79XA?

The Level II codes from the policies most specific to this diagnosis are Q2028 (Injection, sculptra, 0.5 mg, 2 articles); G0429 (Dermal filler injection(s) for the treatment of facial…, 2 articles); Q2026 (Injection, radiesse, 0.1 ml, 2 articles); C8903 (Magnetic resonance imaging with contrast, breast; unilateral, 1 article); C8905 (Magnetic resonance imaging without contrast followed by…, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list T85.79XA?

A52849 (Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography); A59299 (Billing and Coding: Cosmetic and Reconstructive Surgery); A58774 (Billing and Coding: Cosmetic and Reconstructive Surgery), and 5 more articles.

What is ICD-10-CM code T85.79XA?

T85.79XA is the ICD-10-CM code for infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, 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