T86.31: Heart-lung transplant rejection

T86.31, heart-lung transplant rejection, is listed as a covered diagnosis in 17 Medicare billing and coding articles that apply to 117 HCPCS Level II codes, including J1569 (Injection, immune globulin, (gammagard liquid/gammagard…), J1561 (Injection, immune globulin, (gamunex-c/gammaked)…), J1459 (Injection, immune globulin (privigen), intravenous…). 20 of these codes have a 2026 DMEPOS fee schedule amount; K0730 pays $245.69 (RR) depending on the state. The articles come from 6 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 T86.31 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
J1569Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mgSpecial coverage instructions apply—3
J1561Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mgSpecial coverage instructions apply—3
J1459Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—3
J1576Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mgSpecial coverage instructions apply—3
J1557Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—3
J1556Injection, immune globulin (bivigam), 500 mgCarrier judgment—3
J1568Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—3
J1566Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mgSpecial coverage instructions apply—3
J1554Injection, immune globulin (asceniv), 500 mgCarrier judgment—3
J1577Injection, immune globulin (qivigy), 100 mgCarrier judgment—3
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)Special coverage instructions apply—6
J1250Injection, dobutamine hydrochloride, per 250 mgSpecial coverage instructions apply—6
J1245Injection, dipyridamole, per 10 mgSpecial coverage instructions apply—6
J9312Injection, rituximab, 10 mgSpecial coverage instructions apply—3
Q5119Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mgCarrier judgment—3
Q5115Injection, rituximab-abbs, biosimilar, (truxima), 10 mgSpecial coverage instructions apply—3
A9500Technetium tc-99m sestamibi, diagnostic, per study doseCarrier judgment—3
A9502Technetium tc-99m tetrofosmin, diagnostic, per study doseCarrier judgment—3
A9505Thallium tl-201 thallous chloride, diagnostic, per millicurieCarrier judgment—3
A9501Technetium tc-99m teboroxime, diagnostic, per study doseCarrier judgment—3
J1559Injection, immune globulin (hizentra), 100 mgCarrier judgment—2
J1555Injection, immune globulin (cuvitru), 100 mgCarrier judgment—2
J1575Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulinCarrier judgment—2
J1558Injection, immune globulin (xembify), 100 mgCarrier judgment—2
J1551Injection, immune globulin (cutaquig), 100 mgCarrier judgment—2

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

Medicare policy articles listing T86.31

2 more articles list T86.31.

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 T86 diagnoses (Complications of transplanted organs and tissue)

Frequently asked questions

Does Medicare cover T86.31 (Heart-lung transplant rejection)?

Medicare covers items and services, not diagnoses. 17 Medicare billing and coding articles list T86.31 as a covered diagnosis for 117 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 T86.31?

The Level II codes from the policies most specific to this diagnosis are J1569 (Injection, immune globulin, (gammagard liquid/gammagard…, 3 articles); J1561 (Injection, immune globulin, (gamunex-c/gammaked)…, 3 articles); J1459 (Injection, immune globulin (privigen), intravenous…, 3 articles); J1576 (Injection, immune globulin (panzyga), intravenous…, 3 articles); J1557 (Injection, immune globulin, (gammaplex), intravenous…, 3 articles). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with T86.31?

Under the 2026 DMEPOS fee schedule (non-rural state fees): K0730 $245.69 (RR); E1372 $136.61 to $208.94 (NU); A7017 $130.82 to $194.58 (NU); E0580 $164.65 to $182.27 (NU). Medicare pays 80% of the allowed amount after the Part B deductible.

Which Medicare policy articles list T86.31?

A58582 (Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars); A52474 (Immunosuppressive Drugs - Policy Article); A56786 (Billing and Coding: Immune Globulin), and 14 more articles.

What is ICD-10-CM code T86.31?

T86.31 is the ICD-10-CM code for heart-lung transplant rejection, in category T86 (Complications of transplanted organs and tissue), 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