Z94.1: Heart transplant status

Z94.1, heart transplant status, is listed as a covered diagnosis in 23 Medicare billing and coding articles that apply to 70 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 Z94.1 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
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)Special coverage instructions apply—5
J1250Injection, dobutamine hydrochloride, per 250 mgSpecial coverage instructions apply—5
J1245Injection, dipyridamole, per 10 mgSpecial coverage instructions apply—5
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
J3490Unclassified drugsSpecial coverage instructions apply—3
A9500Technetium tc-99m sestamibi, diagnostic, per study doseCarrier judgment—2
A9502Technetium tc-99m tetrofosmin, diagnostic, per study doseCarrier judgment—2
A9505Thallium tl-201 thallous chloride, diagnostic, per millicurieCarrier judgment—2
A9512Technetium tc-99m pertechnetate, diagnostic, per millicurieCarrier judgment—2
A9560Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuriesCarrier judgment—2
A9538Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuriesCarrier judgment—2

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

Medicare policy articles listing Z94.1

8 more articles list Z94.1.

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 Z94 diagnoses (Transplanted organ and tissue status)

Frequently asked questions

Does Medicare cover Z94.1 (Heart transplant status)?

Medicare covers items and services, not diagnoses. 23 Medicare billing and coding articles list Z94.1 as a covered diagnosis for 70 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 Z94.1?

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 Z94.1?

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 20 more articles.

What is ICD-10-CM code Z94.1?

Z94.1 is the ICD-10-CM code for heart transplant status, in category Z94 (Transplanted organ and tissue status), 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