Z48.21: Encounter for aftercare following heart transplant

Z48.21, encounter for aftercare following heart transplant, is listed as a covered diagnosis in 18 Medicare billing and coding articles that apply to 67 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…). The articles come from 7 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 Z48.21 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—4
J1561Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mgSpecial coverage instructions apply—4
J1459Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—4
J1557Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—4
J1556Injection, immune globulin (bivigam), 500 mgCarrier judgment—4
J1568Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—4
J1566Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mgSpecial coverage instructions apply—4
J1554Injection, immune globulin (asceniv), 500 mgCarrier judgment—4
J1599Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mgCarrier judgment—4
J1576Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mgSpecial coverage instructions apply—3
J1552Injection, immune globulin (alyglo), 500 mgCarrier judgment—3
J1577Injection, immune globulin (qivigy), 100 mgCarrier judgment—3
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—4
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—4
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—4
G0422Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per sessionCarrier judgment—1
G0423Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per sessionCarrier judgment—1
Q0512Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day periodSpecial coverage instructions apply—1
Q0511Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day periodSpecial coverage instructions apply—1
J7510Prednisolone oral, per 5 mgSpecial coverage instructions apply—1
Q0510Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplantSpecial coverage instructions apply—1
J7599Immunosuppressive drug, not otherwise classifiedSpecial coverage instructions apply—1
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)Special coverage instructions apply—4
J1250Injection, dobutamine hydrochloride, per 250 mgSpecial coverage instructions apply—4
J1245Injection, dipyridamole, per 10 mgSpecial coverage instructions apply—4

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

Medicare policy articles listing Z48.21

3 more articles list Z48.21.

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 Z48 diagnoses (Encounter for other postprocedural aftercare)

Frequently asked questions

Does Medicare cover Z48.21 (Encounter for aftercare following heart transplant)?

Medicare covers items and services, not diagnoses. 18 Medicare billing and coding articles list Z48.21 as a covered diagnosis for 67 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 Z48.21?

The Level II codes from the policies most specific to this diagnosis are J1569 (Injection, immune globulin, (gammagard liquid/gammagard…, 4 articles); J1561 (Injection, immune globulin, (gamunex-c/gammaked)…, 4 articles); J1459 (Injection, immune globulin (privigen), intravenous…, 4 articles); J1557 (Injection, immune globulin, (gammaplex), intravenous…, 4 articles); J1556 (Injection, immune globulin (bivigam), 500 mg, 4 articles). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list Z48.21?

A53775 (Billing and Coding: Frequency and Duration for Cardiac Rehabilitation and Intensive Cardiac Rehabilitation); A52474 (Immunosuppressive Drugs - Policy Article); A57187 (Billing and Coding: Immune Globulin Intravenous (IVIg)), and 15 more articles.

What is ICD-10-CM code Z48.21?

Z48.21 is the ICD-10-CM code for encounter for aftercare following heart transplant, in category Z48 (Encounter for other postprocedural aftercare), chapter 22: Factors influencing health status and contact with health services.

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 22: Factors influencing health status and contact with health services · All diagnoses · HCPCS lookup