N64.4 — Mastodynia
N64.4 is a billable, specific ICD-10-CM code for mastodynia. It is valid for submission on a claim.
Other codes that can never be billed with N64.4
These codes carry an Excludes1 note pointing at N64.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading N64.4 alone.
- R52Pain, unspecified
Risk adjustment
N64.4 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
N64.4 is named in 10 Medicare coverage policies — 10 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52849Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
- A53065Billing and Coding: Outpatient Physical Therapy
- A56448Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
- A56448Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
How N64.4 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to N64.4.
- Mastalgia
- Mastodynia
- Pain›breast
Related codes at this level
Codes that share N64. If N64.4 is not quite right, the correct code is usually one of these.
Questions about N64.4
- Is N64.4 a billable ICD-10-CM code?
- Yes. N64.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does N64.4 sit in the tabular list?
- Diseases of the genitourinary system (N00-N99), in the block Disorders of breast (N60-N65).