T86.811: Lung transplant failure
T86.811, lung transplant failure, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 75 HCPCS Level II codes, including Q0512 (Pharmacy supply fee for oral anti-cancer, oral anti-emetic…), Q0511 (Pharmacy supply fee for oral anti-cancer, oral anti-emetic…), J7510 (Prednisolone oral, per 5 mg). 20 of these codes have a 2026 DMEPOS fee schedule amount; K0730 pays $245.69 (RR) 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 T86.811 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| Q0512 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period | Special coverage instructions apply | — | 1 |
| Q0511 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period | Special coverage instructions apply | — | 1 |
| J7510 | Prednisolone oral, per 5 mg | Special coverage instructions apply | — | 1 |
| Q0510 | Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant | Special coverage instructions apply | — | 1 |
| J7599 | Immunosuppressive drug, not otherwise classified | Special coverage instructions apply | — | 1 |
| K0730 | Controlled dose inhalation drug delivery system | Carrier judgment | $245.69 (RR) | 1 |
| E1372 | Immersion external heater for nebulizer | Special coverage instructions apply | $136.61–$208.94 (NU) | 1 |
| A7017 | Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen | Special coverage instructions apply | $130.82–$194.58 (NU) | 1 |
| E0580 | Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter | Special coverage instructions apply | $164.65–$182.27 (NU) | 1 |
| E0575 | Nebulizer, ultrasonic, large volume | Special coverage instructions apply | $124.51–$159.48 (RR) | 1 |
| E0565 | Compressor, air power source for equipment which is not self-contained or cylinder driven | Carrier judgment | $42.74–$82.96 (RR) | 1 |
| E0574 | Ultrasonic/electronic aerosol generator with small volume nebulizer | Carrier judgment | $48.76–$67.63 (RR) | 1 |
| E0585 | Nebulizer, with compressor and heater | Special coverage instructions apply | $32.06–$60.76 (RR) | 1 |
| E0572 | Aerosol compressor, adjustable pressure, light duty for intermittent use | Carrier judgment | $29.16–$51.74 (RR) | 1 |
| A7005 | Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable | Carrier judgment | $11.77–$29.20 (NU) | 1 |
| A7008 | Large volume nebulizer, disposable, prefilled, used with aerosol compressor | Carrier judgment | $12.46–$18.09 (NU) | 1 |
| A7016 | Dome and mouthpiece, used with small volume ultrasonic nebulizer | Carrier judgment | $9.31–$17.75 (NU) | 1 |
| E0570 | Nebulizer, with compressor | Special coverage instructions apply | $6.09–$15.43 (RR) | 1 |
| A7006 | Administration set, with small volume filtered pneumatic nebulizer | Carrier judgment | $8.19–$14.94 (NU) | 1 |
| A7007 | Large volume nebulizer, disposable, unfilled, used with aerosol compressor | Carrier judgment | $3.47–$5.87 (NU) | 1 |
| A7012 | Water collection device, used with large volume nebulizer | Carrier judgment | $3.25–$5.03 (NU) | 1 |
| A4217 | Sterile water/saline, 500 ml | Special coverage instructions apply | $2.18–$4.93 | 1 |
| A7003 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable | Carrier judgment | $1.86–$3.26 (NU) | 1 |
| A7004 | Small volume nonfiltered pneumatic nebulizer, disposable | Carrier judgment | $1.51–$2.08 (NU) | 1 |
| A7018 | Water, distilled, used with large volume nebulizer, 1000 ml | Carrier judgment | $0.38–$0.59 | 1 |
50 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing T86.811
- A52474: Immunosuppressive Drugs - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 5 Level II codes). LCD with the same title: L33824
- A52466: Nebulizers - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 53 Level II codes). LCD with the same title: L33370
- A59105: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG) (Wellpoint Federal (MAC - Part A, MAC - Part B); 11 Level II codes). LCD with the same title: L39314
- A55639: Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 6 Level II codes)
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)
- T86.810 — Lung transplant rejection
- T86.812 — Lung transplant infection
- T86.818 — Other complications of lung transplant
- T86.830 — Bone graft rejection
- T86.831 — Bone graft failure
- T86.832 — Bone graft infection
- T86.838 — Other complications of bone graft
- T86.850 — Intestine transplant rejection
- T86.851 — Intestine transplant failure
- T86.852 — Intestine transplant infection
- T86.858 — Other complications of intestine transplant
- T86.890 — Other transplanted tissue rejection
- T86.891 — Other transplanted tissue failure
- T86.892 — Other transplanted tissue infection
- T86.898 — Other complications of other transplanted tissue
- T86.00 — Unspecified complication of bone marrow transplant
- T86.01 — Bone marrow transplant rejection
- T86.02 — Bone marrow transplant failure
- T86.03 — Bone marrow transplant infection
- T86.09 — Other complications of bone marrow transplant
- T86.10 — Unspecified complication of kidney transplant
- T86.11 — Kidney transplant rejection
- T86.12 — Kidney transplant failure
- T86.13 — Kidney transplant infection
- T86.19 — Other complication of kidney transplant
- T86.20 — Unspecified complication of heart transplant
- T86.21 — Heart transplant rejection
- T86.22 — Heart transplant failure
- T86.23 — Heart transplant infection
- T86.290 — Cardiac allograft vasculopathy
Frequently asked questions
Does Medicare cover T86.811 (Lung transplant failure)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list T86.811 as a covered diagnosis for 75 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 T86.811?
The Level II codes from the policies most specific to this diagnosis are Q0512 (Pharmacy supply fee for oral anti-cancer, oral anti-emetic…, 1 article); Q0511 (Pharmacy supply fee for oral anti-cancer, oral anti-emetic…, 1 article); J7510 (Prednisolone oral, per 5 mg, 1 article); Q0510 (Pharmacy supply fee for initial immunosuppressive drug(s)…, 1 article); J7599 (Immunosuppressive drug, not otherwise classified, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with T86.811?
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 T86.811?
A52474 (Immunosuppressive Drugs - Policy Article); A52466 (Nebulizers - Policy Article); A59105 (Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)), and 1 more article.
What is ICD-10-CM code T86.811?
T86.811 is the ICD-10-CM code for lung transplant failure, in category T86 (Complications of transplanted organs and tissue), chapter 19: Injury, poisoning and other consequences of external causes.
Next steps
- Run a reimbursement report for a device billed under Q0512
- Watch Q0512 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q0512
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