Z04.81: Encounter for examination and observation of victim following forced sexual exploitation
Z04.81, encounter for examination and observation of victim following forced sexual exploitation, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 2 HCPCS Level II codes, including U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19)…), U0001 (Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr…). 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 Z04.81 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc | Carrier judgment | — | 4 |
| U0001 | Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel | Carrier judgment | — | 4 |
Medicare policy articles listing Z04.81
- A58710: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (Palmetto GBA (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58720: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58761: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58747: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
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 Z04 diagnoses (Encounter for examination and observation for other reasons)
- Z04.41 — Encounter for examination and observation following alleged adult rape
- Z04.71 — Encounter for examination and observation following alleged adult…
Frequently asked questions
Does Medicare cover Z04.81 (Encounter for examination and observation of victim…)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list Z04.81 as a covered diagnosis for 2 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 Z04.81?
The Level II codes from the policies most specific to this diagnosis are U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19)…, 4 articles); U0001 (Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr…, 4 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list Z04.81?
A58710 (Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing); A58720 (Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing); A58761 (Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing), and 1 more article.
What is ICD-10-CM code Z04.81?
Z04.81 is the ICD-10-CM code for encounter for examination and observation of victim following forced sexual exploitation, in category Z04 (Encounter for examination and observation for other reasons), chapter 22: Factors influencing health status and contact with health services.
Next steps
- Run a reimbursement report for a device billed under U0002
- Watch U0002 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for U0002
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 22: Factors influencing health status and contact with health services · All diagnoses · HCPCS lookup