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MA08.101c
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MA08.101c
ICD-10 Codes and Narratives
Canakinumab (Ilaris®)


ICD-10 CODES AND NARRATIVES

MEDICALLY NECESSARY​

E85.0Non-neuropathic heredofamilial amyloidosis
M04.1Periodic fever syndromes
M04.2Cryopyrin-associated periodic syndromes
M06.1Adult-onset Still's disease
M08.20Juvenile rheumatoid arthritis with systemic onset, unspecified site
M08.211Juvenile rheumatoid arthritis with systemic onset, right shoulder
M08.212Juvenile rheumatoid arthritis with systemic onset, left shoulder
M08.221Juvenile rheumatoid arthritis with systemic onset, right elbow
M08.222Juvenile rheumatoid arthritis with systemic onset, left elbow
M08.231Juvenile rheumatoid arthritis with systemic onset, right wrist
M08.232Juvenile rheumatoid arthritis with systemic onset, left wrist
M08.241Juvenile rheumatoid arthritis with systemic onset, right hand
M08.242Juvenile rheumatoid arthritis with systemic onset, left hand
M08.251Juvenile rheumatoid arthritis with systemic onset, right hip
M08.252Juvenile rheumatoid arthritis with systemic onset, left hip
M08.261Juvenile rheumatoid arthritis with systemic onset, right knee
M08.262Juvenile rheumatoid arthritis with systemic onset, left knee
M08.271Juvenile rheumatoid arthritis with systemic onset, right ankle and foot
M08.272Juvenile rheumatoid arthritis with systemic onset, left ankle and foot
M08.28Juvenile rheumatoid arthritis with systemic onset, vertebrae
M08.29Juvenile rheumatoid arthritis with systemic onset, multiple sites
M08.2AJuvenile rheumatoid arthritis with systemic onset, other specified site
M1A.00X0Idiopathic chronic gout, unspecified site, without tophus (tophi)
M1A.00X1Idiopathic chronic gout, unspecified site, with tophus (tophi)
M1A.0110Idiopathic chronic gout, right shoulder, without tophus (tophi)
M1A.0111Idiopathic chronic gout, right shoulder, with tophus (tophi)
M1A.0120Idiopathic chronic gout, left shoulder, without tophus (tophi)
M1A.0121Idiopathic chronic gout, left shoulder, with tophus (tophi)
M1A.0210Idiopathic chronic gout, right elbow, without tophus (tophi)
M1A.0211Idiopathic chronic gout, right elbow, with tophus (tophi)
M1A.0220Idiopathic chronic gout, left elbow, without tophus (tophi)
M1A.0221Idiopathic chronic gout, left elbow, with tophus (tophi)
M1A.0310Idiopathic chronic gout, right wrist, without tophus (tophi)
M1A.0311Idiopathic chronic gout, right wrist, with tophus (tophi)
M1A.0320Idiopathic chronic gout, left wrist, without tophus (tophi)
M1A.0321Idiopathic chronic gout, left wrist, with tophus (tophi)
M1A.0410Idiopathic chronic gout, right hand, without tophus (tophi)
M1A.0411Idiopathic chronic gout, right hand, with tophus (tophi)
M1A.0420Idiopathic chronic gout, left hand, without tophus (tophi)
M1A.0421Idiopathic chronic gout, left hand, with tophus (tophi)
M1A.0510Idiopathic chronic gout, right hip, without tophus (tophi)
M1A.0511Idiopathic chronic gout, right hip, with tophus (tophi)
M1A.0520Idiopathic chronic gout, left hip, without tophus (tophi)
M1A.0521Idiopathic chronic gout, left hip, with tophus (tophi)
M1A.0610Idiopathic chronic gout, right knee, without tophus (tophi)
M1A.0611Idiopathic chronic gout, right knee, with tophus (tophi)
M1A.0620Idiopathic chronic gout, left knee, without tophus (tophi)
M1A.0621Idiopathic chronic gout, left knee, with tophus (tophi)
M1A.0710Idiopathic chronic gout, right ankle and foot, without tophus (tophi)
M1A.0711Idiopathic chronic gout, right ankle and foot, with tophus (tophi)
M1A.0720Idiopathic chronic gout, left ankle and foot, without tophus (tophi)
M1A.0721Idiopathic chronic gout, left ankle and foot, with tophus (tophi)
M1A.08X0Idiopathic chronic gout, vertebrae, without tophus (tophi)
M1A.08X1Idiopathic chronic gout, vertebrae, with tophus (tophi)
M1A.09X0Idiopathic chronic gout, multiple sites, without tophus (tophi)
M1A.09X1Idiopathic chronic gout, multiple sites, with tophus (tophi)
M1A.10X0Lead-induced chronic gout, unspecified site, without tophus (tophi)
M1A.10X1Lead-induced chronic gout, unspecified site, with tophus (tophi)
M1A.1110Lead-induced chronic gout, right shoulder, without tophus (tophi)
M1A.1111Lead-induced chronic gout, right shoulder, with tophus (tophi)
M1A.1120Lead-induced chronic gout, left shoulder, without tophus (tophi)
M1A.1121Lead-induced chronic gout, left shoulder, with tophus (tophi)
M1A.1210Lead-induced chronic gout, right elbow, without tophus (tophi)
M1A.1211Lead-induced chronic gout, right elbow, with tophus (tophi)
M1A.1220Lead-induced chronic gout, left elbow, without tophus (tophi)
M1A.1221Lead-induced chronic gout, left elbow, with tophus (tophi)
M1A.1310Lead-induced chronic gout, right wrist, without tophus (tophi)
M1A.1311Lead-induced chronic gout, right wrist, with tophus (tophi)
M1A.1320Lead-induced chronic gout, left wrist, without tophus (tophi)
M1A.1321Lead-induced chronic gout, left wrist, with tophus (tophi)
M1A.1410Lead-induced chronic gout, right hand, without tophus (tophi)
M1A.1411Lead-induced chronic gout, right hand, with tophus (tophi)
M1A.1420Lead-induced chronic gout, left hand, without tophus (tophi)
M1A.1421Lead-induced chronic gout, left hand, with tophus (tophi)
M1A.1510Lead-induced chronic gout, right hip, without tophus (tophi)
M1A.1511Lead-induced chronic gout, right hip, with tophus (tophi)
M1A.1520Lead-induced chronic gout, left hip, without tophus (tophi)
M1A.1521Lead-induced chronic gout, left hip, with tophus (tophi)
M1A.1610Lead-induced chronic gout, right knee, without tophus (tophi)
M1A.1611Lead-induced chronic gout, right knee, with tophus (tophi)
M1A.1620Lead-induced chronic gout, left knee, without tophus (tophi)
M1A.1621Lead-induced chronic gout, left knee, with tophus (tophi)
M1A.1710Lead-induced chronic gout, right ankle and foot, without tophus (tophi)
M1A.1711Lead-induced chronic gout, right ankle and foot, with tophus (tophi)
M1A.1720Lead-induced chronic gout, left ankle and foot, without tophus (tophi)
M1A.1721Lead-induced chronic gout, left ankle and foot, with tophus (tophi)
M1A.18X0Lead-induced chronic gout, vertebrae, without tophus (tophi)
M1A.18X1Lead-induced chronic gout, vertebrae, with tophus (tophi)
M1A.19X0Lead-induced chronic gout, multiple sites, without tophus (tophi)
M1A.19X1Lead-induced chronic gout, multiple sites, with tophus (tophi)
M1A.20X0Drug-induced chronic gout, unspecified site, without tophus (tophi)
M1A.20X1Drug-induced chronic gout, unspecified site, with tophus (tophi)
M1A.2110Drug-induced chronic gout, right shoulder, without tophus (tophi)
M1A.2111Drug-induced chronic gout, right shoulder, with tophus (tophi)
M1A.2120Drug-induced chronic gout, left shoulder, without tophus (tophi)
M1A.2121Drug-induced chronic gout, left shoulder, with tophus (tophi)
M1A.2210Drug-induced chronic gout, right elbow, without tophus (tophi)
M1A.2211Drug-induced chronic gout, right elbow, with tophus (tophi)
M1A.2220Drug-induced chronic gout, left elbow, without tophus (tophi)
M1A.2221Drug-induced chronic gout, left elbow, with tophus (tophi)
M1A.2310Drug-induced chronic gout, right wrist, without tophus (tophi)
M1A.2311Drug-induced chronic gout, right wrist, with tophus (tophi)
M1A.2320Drug-induced chronic gout, left wrist, without tophus (tophi)
M1A.2321Drug-induced chronic gout, left wrist, with tophus (tophi)
M1A.2410Drug-induced chronic gout, right hand, without tophus (tophi)
M1A.2411Drug-induced chronic gout, right hand, with tophus (tophi)
M1A.2420Drug-induced chronic gout, left hand, without tophus (tophi)
M1A.2421Drug-induced chronic gout, left hand, with tophus (tophi)
M1A.2510Drug-induced chronic gout, right hip, without tophus (tophi)
M1A.2511Drug-induced chronic gout, right hip, with tophus (tophi)
M1A.2520Drug-induced chronic gout, left hip, without tophus (tophi)
M1A.2521Drug-induced chronic gout, left hip, with tophus (tophi)
M1A.2610Drug-induced chronic gout, right knee, without tophus (tophi)
M1A.2611Drug-induced chronic gout, right knee, with tophus (tophi)
M1A.2620Drug-induced chronic gout, left knee, without tophus (tophi)
M1A.2621Drug-induced chronic gout, left knee, with tophus (tophi)
M1A.2710Drug-induced chronic gout, right ankle and foot, without tophus (tophi)
M1A.2711Drug-induced chronic gout, right ankle and foot, with tophus (tophi)
M1A.2720Drug-induced chronic gout, left ankle and foot, without tophus (tophi)
M1A.2721Drug-induced chronic gout, left ankle and foot, with tophus (tophi)
M1A.28X0Drug-induced chronic gout, vertebrae, without tophus (tophi)
M1A.28X1Drug-induced chronic gout, vertebrae, with tophus (tophi)
M1A.29X0Drug-induced chronic gout, multiple sites, without tophus (tophi)
M1A.29X1Drug-induced chronic gout, multiple sites, with tophus (tophi)
M1A.30X0Chronic gout due to renal impairment, unspecified site, without tophus (tophi)
M1A.30X1Chronic gout due to renal impairment, unspecified site, with tophus (tophi)
M1A.3110Chronic gout due to renal impairment, right shoulder, without tophus (tophi)
M1A.3111Chronic gout due to renal impairment, right shoulder, with tophus (tophi)
M1A.3120Chronic gout due to renal impairment, left shoulder, without tophus (tophi)
M1A.3121Chronic gout due to renal impairment, left shoulder, with tophus (tophi)
M1A.3210Chronic gout due to renal impairment, right elbow, without tophus (tophi)
M1A.3211Chronic gout due to renal impairment, right elbow, with tophus (tophi)
M1A.3220Chronic gout due to renal impairment, left elbow, without tophus (tophi)
M1A.3221Chronic gout due to renal impairment, left elbow, with tophus (tophi)
M1A.3310Chronic gout due to renal impairment, right wrist, without tophus (tophi)
M1A.3311Chronic gout due to renal impairment, right wrist, with tophus (tophi)
M1A.3320Chronic gout due to renal impairment, left wrist, without tophus (tophi)
M1A.3321Chronic gout due to renal impairment, left wrist, with tophus (tophi)
M1A.3410Chronic gout due to renal impairment, right hand, without tophus (tophi)
M1A.3411Chronic gout due to renal impairment, right hand, with tophus (tophi)
M1A.3420Chronic gout due to renal impairment, left hand, without tophus (tophi)
M1A.3421Chronic gout due to renal impairment, left hand, with tophus (tophi)
M1A.3510Chronic gout due to renal impairment, right hip, without tophus (tophi)
M1A.3511Chronic gout due to renal impairment, right hip, with tophus (tophi)
M1A.3520Chronic gout due to renal impairment, left hip, without tophus (tophi)
M1A.3521Chronic gout due to renal impairment, left hip, with tophus (tophi)
M1A.3610Chronic gout due to renal impairment, right knee, without tophus (tophi)
M1A.3611Chronic gout due to renal impairment, right knee, with tophus (tophi)
M1A.3620Chronic gout due to renal impairment, left knee, without tophus (tophi)
M1A.3621Chronic gout due to renal impairment, left knee, with tophus (tophi)
M1A.3710Chronic gout due to renal impairment, right ankle and foot, without tophus (tophi)
M1A.3711Chronic gout due to renal impairment, right ankle and foot, with tophus (tophi)
M1A.3720Chronic gout due to renal impairment, left ankle and foot, without tophus (tophi)
M1A.3721Chronic gout due to renal impairment, left ankle and foot, with tophus (tophi)
M1A.38X0Chronic gout due to renal impairment, vertebrae, without tophus (tophi)
M1A.38X1Chronic gout due to renal impairment, vertebrae, with tophus (tophi)
M1A.39X1Chronic gout due to renal impairment, multiple sites, with tophus (tophi)
M1A.40X0Other secondary chronic gout, unspecified site, without tophus (tophi)
M1A.40X1Other secondary chronic gout, unspecified site, with tophus (tophi)
M1A.4110Other secondary chronic gout, right shoulder, without tophus (tophi)
M1A.4111Other secondary chronic gout, right shoulder, with tophus (tophi)
M1A.4120Other secondary chronic gout, left shoulder, without tophus (tophi)
M1A.4121Other secondary chronic gout, left shoulder, with tophus (tophi)
M1A.4210Other secondary chronic gout, right elbow, without tophus (tophi)
M1A.4211Other secondary chronic gout, right elbow, with tophus (tophi)
M1A.4220Other secondary chronic gout, left elbow, without tophus (tophi)
M1A.4221Other secondary chronic gout, left elbow, with tophus (tophi)
M1A.4310Other secondary chronic gout, right wrist, without tophus (tophi)
M1A.4311Other secondary chronic gout, right wrist, with tophus (tophi)
M1A.4320Other secondary chronic gout, left wrist, without tophus (tophi)
M1A.4321Other secondary chronic gout, left wrist, with tophus (tophi)
M1A.4410Other secondary chronic gout, right hand, without tophus (tophi)
M1A.4411Other secondary chronic gout, right hand, with tophus (tophi)
M1A.4420Other secondary chronic gout, left hand, without tophus (tophi)
M1A.4421Other secondary chronic gout, left hand, with tophus (tophi)
M1A.4510Other secondary chronic gout, right hip, without tophus (tophi)
M1A.4511Other secondary chronic gout, right hip, with tophus (tophi)
M1A.4520Other secondary chronic gout, left hip, without tophus (tophi)
M1A.4521Other secondary chronic gout, left hip, with tophus (tophi)
M1A.4610Other secondary chronic gout, right knee, without tophus (tophi)
M1A.4611Other secondary chronic gout, right knee, with tophus (tophi)
M1A.4620Other secondary chronic gout, left knee, without tophus (tophi)
M1A.4621Other secondary chronic gout, left knee, with tophus (tophi)
M1A.4710Other secondary chronic gout, right ankle and foot, without tophus (tophi)
M1A.4711Other secondary chronic gout, right ankle and foot, with tophus (tophi)
M1A.4720Other secondary chronic gout, left ankle and foot, without tophus (tophi)
M1A.4721Other secondary chronic gout, left ankle and foot, with tophus (tophi)
M1A.48X0Other secondary chronic gout, vertebrae, without tophus (tophi)
M1A.48X1Other secondary chronic gout, vertebrae, with tophus (tophi)
M1A.49X0Other secondary chronic gout, multiple sites, without tophus (tophi)
M1A.49X1Other secondary chronic gout, multiple sites, with tophus (tophi)
M1A.9XX0Chronic gout, unspecified, without tophus (tophi)
M1A.9XX1Chronic gout, unspecified, with tophus (tophi)​​

01/06/2025
12/30/2024
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Medical Policy Bulletin
Medicare Advantage
c369338c-9e54-4e41-93f5-8ab849749d7b
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