Z91.89: Other specified personal risk factors, not elsewhere classified

Z91.89, other specified personal risk factors, not elsewhere classified, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 12 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 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 Z91.89 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—1
J1561Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mgSpecial coverage instructions apply—1
J1459Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—1
J1557Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—1
J1556Injection, immune globulin (bivigam), 500 mgCarrier judgment—1
J1568Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—1
J1566Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mgSpecial coverage instructions apply—1
J1572Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mgSpecial coverage instructions apply—1
J1552Injection, immune globulin (alyglo), 500 mgCarrier judgment—1
J1740Injection, ibandronate sodium, 1 mgCarrier judgment—1
G0278Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure)Carrier judgment—1
G0269Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug)Special coverage instructions apply—1

Medicare policy articles listing Z91.89

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 Z91 diagnoses (Personal risk factors, not elsewhere classified)

Frequently asked questions

Does Medicare cover Z91.89 (Other specified personal risk factors, not elsewhere…)?

Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list Z91.89 as a covered diagnosis for 12 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 Z91.89?

The Level II codes from the policies most specific to this diagnosis are J1569 (Injection, immune globulin, (gammagard liquid/gammagard…, 1 article); J1561 (Injection, immune globulin, (gamunex-c/gammaked)…, 1 article); J1459 (Injection, immune globulin (privigen), intravenous…, 1 article); J1557 (Injection, immune globulin, (gammaplex), intravenous…, 1 article); J1556 (Injection, immune globulin (bivigam), 500 mg, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list Z91.89?

A56779 (Billing and Coding: Intravenous Immune Globulin); A52421 (Billing and Coding: Ibandronate Sodium); A56500 (Billing and Coding: Cardiac Catheterization and Coronary Angiography).

What is ICD-10-CM code Z91.89?

Z91.89 is the ICD-10-CM code for other specified personal risk factors, not elsewhere classified, in category Z91 (Personal risk factors, not elsewhere classified), 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