G40.901 — Epilepsy, unspecified, not intractable, with status epilepticus

Code definition & billing validity

Coding context for G40.901

Epilepsy codes fall under Chapter VI — Diseases of the nervous system. MAC LCDs specify EEG and neurology monitoring coverage criteria for seizure disorder management.

Source: CDC ICD-10-CM Tabular List · CMS National Coverage Analysis

Coverage check · verified

Which Medicare LCDs cover G40.901, by MAC?

The LCDs whose CMS Billing & Coding article lists G40.901as covered or non-covered — each jurisdiction, effective-dated, linked to the government document. No guesses; if a policy isn’t on file we say so.

MAC coverage considerations

Local Coverage Determinations (LCDs) from Medicare Administrative Contractors may impose medical necessity requirements for services billed with G40.901. Coverage criteria vary by MAC jurisdiction. Every contractor publishes its LCDs to the CMS Medicare Coverage Database, and CLV Intelligence tracks that database daily for LCD updates affecting this code and related codes.

MAC jurisdiction coverage

All seven Medicare Administrative Contractors (MACs) are monitored daily for LCD revisions, billing guidance, and coverage policy updates affecting ICD-10-CM G40.901.

Related ICD-10-CM codes & category

Frequently asked

What are the active CMS reimbursement alerts for ICD-10-CM code G40.901?

According to CLV Intelligence data, 1 active CMS and MAC reimbursement policy changes are matched to ICD-10-CM code G40.901 (Epilepsy, unspecified, not intractable, with status epilepticus) by CLV analysis of each policy. Of these, 1 are classified as Critical or High priority based on signal scoring of source authority, effective date urgency, and regulatory type. Policies are sourced from CMS transmittals, Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCDs), and Federal Register notices; the linked source document is authoritative. Data is updated daily.

Which MAC contractors publish LCD or billing guidance for G40.901?

According to CLV Intelligence data, Local Coverage Determinations (LCDs) and billing guidance relevant to ICD-10-CM code G40.901 (Epilepsy, unspecified, not intractable, with status epilepticus) may be issued by any of the seven Medicare Administrative Contractors (MACs): Noridian Healthcare Solutions (Jurisdictions E and F), CGS Administrators (Jurisdiction 15), Palmetto GBA (Jurisdictions J and M), NGS (Jurisdictions 6 and K), WPS Government Health Administrators (Jurisdictions 5 and 8), First Coast Service Options (Jurisdiction N), and Novitas Solutions (Jurisdictions H and L). CLV Intelligence monitors all MAC jurisdictions daily and surfaces alerts by jurisdiction so clinical coders can filter to their region.

Is ICD-10-CM code G40.901 billable under Medicare in 2025–2026?

ICD-10-CM code G40.901 — Epilepsy, unspecified, not intractable, with status epilepticus — is a valid billable diagnosis code under the ICD-10-CM FY2026 code set maintained by the Centers for Disease Control and Prevention (CDC) and adopted by CMS for Medicare and Medicaid billing. CLV Intelligence tracks CMS fee schedule updates, LCD revisions, and coverage policy changes that may affect reimbursement eligibility for this code. Coders should verify against the most recent MAC LCD and CMS NCCI edits before submission.

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