Non-covered diagnoses (ICD-10) for reimbursement mapping
Lists ICD-10 diagnosis codes that are considered non-covered for Neighborhood Health Plan of Rhode Island and shows mappings between commercial and internal (INTEGRITY) coding references; affects claims processing and payer reimbursement determinations.
No material clinical or coverage changes in this revision.
Non-covered Diagnoses
Non-covered diagnoses
The following ICD-10 diagnosis codes and ranges are designated as non-covered for reimbursement purposes. Commercial → INTEGRITY mapping is shown where provided; some mappings are incomplete in the source.
ALL of the following
- N46.01-N46.9 — Commercial = L70.0-L70.9; INTEGRITY = N46.01-N46.9
- N52.9 — Commercial = L73.0; INTEGRITY = N52.9
- N97.0-N97.9 — Commercial = L80; INTEGRITY = N52.9
- Z00.8 — Commercial = N52.9; INTEGRITY = N97.0-N97.9
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