Z94.81: Bone marrow transplant status

Z94.81, bone marrow transplant status, is listed as a covered diagnosis in 16 Medicare billing and coding articles that apply to 53 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 5 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 Z94.81 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
J9312Injection, rituximab, 10 mgSpecial coverage instructions apply—2
Q5119Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mgCarrier judgment—2
Q5115Injection, rituximab-abbs, biosimilar, (truxima), 10 mgSpecial coverage instructions apply—2
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—2
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—2
U00022019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdcCarrier judgment—4
U0001Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panelCarrier judgment—4
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
J1553Injection, immune globulin (yimmugo), 100 mgCarrier judgment—1
J2791Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iuSpecial coverage instructions apply—1
J2792Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iuSpecial coverage instructions apply—1

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

Medicare policy articles listing Z94.81

1 more articles list Z94.81.

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 Z94.81 (Bone marrow transplant status)?

Medicare covers items and services, not diagnoses. 16 Medicare billing and coding articles list Z94.81 as a covered diagnosis for 53 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 Z94.81?

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 Z94.81?

A58582 (Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars); A52474 (Immunosuppressive Drugs - Policy Article); A57187 (Billing and Coding: Immune Globulin Intravenous (IVIg)), and 13 more articles.

What is ICD-10-CM code Z94.81?

Z94.81 is the ICD-10-CM code for bone marrow 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