Z89.221: Acquired absence of right upper limb above elbow

Z89.221, acquired absence of right upper limb above elbow, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 15 HCPCS Level II codes, including G0283 (Electrical stimulation (unattended), to one or more areas…), G0151 (Services performed by a qualified physical therapist in…), G0329 (Electromagnetic therapy, to one or more areas for chronic…). The articles come from 2 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 Z89.221 as a covered diagnosis

Code	Description	Medicare coverage	DMEPOS fee 2026 (state range)	Articles listing it
G0283	Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care	Carrier judgment	—	2
G0151	Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes	Carrier judgment	—	2
G0329	Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care	Carrier judgment	—	2
G0152	Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes	Carrier judgment	—	1
G0158	Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes	Carrier judgment	—	1
G0160	Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes	Carrier judgment	—	1
G2169	Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes	Carrier judgment	—	1
G2010	Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment	Carrier judgment	—	1
G2250	Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment	Carrier judgment	—	1
G0281	Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care	Carrier judgment	—	1
G2251	Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion	Carrier judgment	—	1
G0157	Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes	Carrier judgment	—	1
G0159	Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes	Carrier judgment	—	1
G2168	Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes	Carrier judgment	—	1
L1972	Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, off-the shelf	Carrier judgment	—	1

Medicare policy articles listing Z89.221

A53057: Billing and Coding: Home Health Occupational Therapy (Palmetto GBA (HHH MAC); 5 Level II codes). LCD with the same title: L34560
A57311: Billing and Coding: Physical Therapy - Home Health (CGS Administrators, LLC (HHH MAC); 7 Level II codes). LCD with the same title: L33942
A53058: Billing and Coding: Home Health Physical Therapy (Palmetto GBA (HHH MAC); 6 Level II codes). LCD with the same title: L34564

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 Z89 diagnoses (Acquired absence of limb)

Z89.222 — Acquired absence of left upper limb above elbow
Z89.211 — Acquired absence of right upper limb below elbow
Z89.212 — Acquired absence of left upper limb below elbow
Z89.231 — Acquired absence of right shoulder
Z89.232 — Acquired absence of left shoulder
Z89.011 — Acquired absence of right thumb
Z89.012 — Acquired absence of left thumb
Z89.021 — Acquired absence of right finger(s)
Z89.022 — Acquired absence of left finger(s)
Z89.111 — Acquired absence of right hand
Z89.112 — Acquired absence of left hand
Z89.121 — Acquired absence of right wrist
Z89.122 — Acquired absence of left wrist
Z89.511 — Acquired absence of right leg below knee
Z89.512 — Acquired absence of left leg below knee
Z89.521 — Acquired absence of right knee
Z89.522 — Acquired absence of left knee
Z89.611 — Acquired absence of right leg above knee
Z89.612 — Acquired absence of left leg above knee
Z89.621 — Acquired absence of right hip joint
Z89.622 — Acquired absence of left hip joint

Frequently asked questions

Does Medicare cover Z89.221 (Acquired absence of right upper limb above elbow)?

Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list Z89.221 as a covered diagnosis for 15 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 Z89.221?

The Level II codes from the policies most specific to this diagnosis are G0283 (Electrical stimulation (unattended), to one or more areas…, 2 articles); G0151 (Services performed by a qualified physical therapist in…, 2 articles); G0329 (Electromagnetic therapy, to one or more areas for chronic…, 2 articles); G0152 (Services performed by a qualified occupational therapist…, 1 article); G0158 (Services performed by a qualified occupational therapist…, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list Z89.221?

A53057 (Billing and Coding: Home Health Occupational Therapy); A57311 (Billing and Coding: Physical Therapy - Home Health); A53058 (Billing and Coding: Home Health Physical Therapy).

What is ICD-10-CM code Z89.221?

Z89.221 is the ICD-10-CM code for acquired absence of right upper limb above elbow, in category Z89 (Acquired absence of limb), chapter 22: Factors influencing health status and contact with health services.

Next steps

Compiled by Caduvo from public CMS (Medicare) records, ICD-10-CM FY2026, HCPCS release October 2026, 2026 fee schedule (non-rural state fees). Not reviewed or endorsed by CMS. Not billing or legal advice. Report an error. Data and corrections policy.

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