Medicare Advantage Plans

ICD-10 Information

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). It contains codes that classify diseases and health problems. To learn more, review the following ICD-10 frequently asked questions and answers.

ICD-10 Frequently Asked Questions and Answers

All entities covered by the Health Insurance Portability and Accountability Act (HIPAA) of 1996 must now conduct healthcare transactions using the ICD-10 diagnosis and procedure codes.

  • Q. What is CarePlus' standard for ICD-10 acceptance?

    A. CarePlus accepts ICD-10 codes on claims with a date of service or discharge date of Oct. 1, 2015, or after.

  • Q. Did CarePlus change medical necessity requirements because of the more specific codes that are available?

    A. Yes. CarePlus has reviewed and updated medical necessity criteria to incorporate ICD-10 terminology and expanded coding.

  • Q. Did CarePlus update medical review policies, coverage determinations and payment determinations?

    A. Yes. CarePlus has reviewed and updated medical necessity criteria to incorporate ICD-10 terminology and expanded coding.

  • Q. Who from CarePlus can I contact if I have questions about ICD-10?

    A. Healthcare providers who have questions or concerns can submit an email to CPHP_MRA@careplus-hp.com. (link opens in new window)

Disclaimer: The information contained on this website provides a general overview of ICD-10 and should not be used as legal advice for implementation activities. We encourage you to seek any professional advice you may need, including legal counsel, regarding how the requirements affect your specific practice. CarePlus is providing the information on this site for general informational purposes only.

For ICD-10 information or training, CarePlus suggests contacting the American Medical Association, the Centers for Medicare & Medicaid Services (CMS), Workgroup for Electronic Data Interchange, American Health Information Management Association, American Academy of Professional Coders or other associations that provide ICD-10 training directly to healthcare providers.