ICD-10-CM Y65 diagnosis code reimbursement policy
Governs Molina Healthcare's reimbursement stance and claim handling for services billed with ICD-10-CM Y65 series (complications/misadventures of medical and surgical care) and affects Molina providers submitting professional and facility claims.
Introduced Y65.8 as a specific code for other specified misadventures in the 2024 ICD-10-CM edition.
Removed FYI: missing Y65.4
Updated policy template on 08/04/2025.
Coverage and Billing Rules for Y65
inv-01: Y65 billing rules
Billing and payment rules for Y65 codes
Prohibited payments
- Facility claims with diagnosis codes Y65.51, Y65.52, or Y65.53 are not paid by Molina Healthcare.
- Professional claims submitted with Modifiers PA, PB, or PC (indicating a medical mistake during surgery or medical care) are not paid by Molina Healthcare.
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