Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.17 - Table of Rare and Expensive Disease Diagnosis

Current through Register Vol. 51, No. 14, July 12, 2024
ICD10
ICD 10 Description
Age Limit
B20
Human immunodeficiency virus (HIV) disease
0-20
C96.0
Multifocal and multisystemic Langerhans-cell
								histiocytosis
0-64
C96.5
Multifocal and unisystemic Langerhans-cell
								histiocytosis
0-64
C96.6
Unifocal Langerhans-cell histiocytosis
0-64
D61.01
Constitutional (pure) red blood cell aplasia
0-20
D61.09
Other constitutional aplastic anemia
0-20
D66
Hereditary factor VIII deficiency
0-64
D67
Hereditary factor IX deficiency
0-64
D68.00
Von Willebrand disease, unspecified
0-64
D68.01
Von Willebrand disease, type 1
0-64
D68.020
Von Willebrand disease, type 2A
0-64
D68.021
Von Willebrand disease, type 2B
0-64
D68.022
Von Willebrand disease, type 2M
0-64
D68.023
Von Willebrand disease, type 2N
0-64
D68.029
Von Willebrand disease, type 2, unspecified
0-64
D68.03
Von Willebrand disease, type 3
0-64
D68.04
Acquired von Willebrand disease
0-64
D68.09
Other von Willebrand disease
0-64
D68.1
Hereditary factor XI deficiency
0-64
D68.2
Hereditary deficiency of other clotting
								factors
0-64
E70.0
Classical phenylketonuria
0-20
E70.1
Other hyperphenylalaninemias
0-20
E70.20
Disorder of tyrosine metabolism, unspecified
0-20
E70.21
Tyrosinemia
0-20
E70.29
Other disorders of tyrosine metabolism
0-20
E70.30
Albinism, unspecified
0-20
E70.40
Disorders of histidine metabolism,
								unspecified
0-20
E70.41
Histidinemia
0-20
E70.49
Other disorders of histidine metabolism
0-20
E70.5
Disorders of tryptophan metabolism
0-20
E70.81
Aromatic L-amino acid decarboxylase
								deficiency
0-20
E70.89
Other disorders of aromatic amino-acid
								metabolism
0-20
E71.0
Maple-syrup-urine disease
0-20
E71.110
Isovaleric acidemia
0-20
E71.111
3-methylglutaconic aciduria
0-20
E71.118
Other branched-chain organic acidurias
0-20
E71.120
Methylmalonic acidemia
0-20
E71.121
Propionic acidemia
0-20
E71.128
Other disorders of propionate metabolism
0-20
E71.19
Other disorders of branched-chain amino-acid
								metabolism
0-20
E71.2
Disorder of branched-chain amino-acid metabolism,
								unspecified
0-20
E71.310
Long chain/very long chain acyl CoA dehydrogenase
								deficiency
0-64
E71.311
Medium chain acyl CoA dehydrogenase
								deficiency
0-64
E71.312
Short chain acyl CoA dehydrogenase
								deficiency
0-64
E71.313
Glutaric aciduria type II
0-64
E71.314
Muscle carnitine palmitoyltransferase
								deficiency
0-64
E71.318
Other disorders of fatty-acid oxidation
0-64
E71.32
Disorders of ketone metabolism
0-64
E71.39
Other disorders of fatty-acid metabolism
0-64
E71.41
Primary carnitine deficiency
0-64
E71.42
Carnitine deficiency due to inborn errors of
								metabolism
0-64
E71.50
Peroxisomal disorder, unspecified
0-64
E71.510
Zellweger syndrome
0-64
E71.511
Neonatal adrenoleukodystrophy
0-64
E71.518
Other disorders of peroxisome biogenesis
0-64
E71.520
Childhood cerebral X-linked
								adrenoleukodystrophy
0-64
E71.521
Adolescent X-linked adrenoleukodystrophy
0-64
E71.522
Adrenomyeloneuropathy
0-64
E71.528
Other X-linked adrenoleukodystrophy
0-64
E71.529
X-linked adrenoleukodystrophy, unspecified
								type
0-64
E71.53
Other group 2 peroxisomal disorders
0-64
E71.540
Rhizomelic chondrodysplasia punctata
0-64
E71.541
Zellweger-like syndrome
0-64
E71.542
Other group 3 peroxisomal disorders
0-64
E71.548
Other peroxisomal disorders
0-64
E72.01
Cystinuria
0-20
E72.02
Hartnup's disease
0-20
E72.03
Lowe's syndrome
0-20
E72.04
Cystinosis
0-20
E72.09
Other disorders of amino-acid transport
0-20
E72.11
Homocystinuria
0-20
E72.12
Methylenetetrahydrofolate reductase
								deficiency
0-20
E72.19
Other disorders of sulfur-bearing amino-acid
								metabolism
0-20
E72.20
Disorder of urea cycle metabolism,
								unspecified
0-20
E72.21
Argininemia
0-20
E72.22
Arginosuccinic aciduria
0-20
E72.23
Citrullinemia
0-20
E72.29
Other disorders of urea cycle metabolism
0-20
E72.3
Disorders of lysine and hydroxylysine
								metabolism
0-20
E72.4
Disorders of ornithine metabolism
0-20
E72.51
Non-ketotic hyperglycinemia
0-20
E72.52
Trimethylaminuria
0-20
E72.53
Primary hyperoxaluria
0-20
E72.59
Other disorders of glycine metabolism
0-20
E72.89
Other specified disorders of amino-acid
								metabolism
0-20
E74.00
Glycogen storage disease, unspecified
0-20
E74.01
von Gierke disease
0-20
E74.02
Pompe disease
0-20
E74.03
Cori disease
0-20
E74.04
McArdle disease
0-20
E74.09
Other glycogen storage disease
0-20
E74.12
Hereditary fructose intolerance
0-20
E74.19
Other disorders of fructose metabolism
0-20
E74.21
Galactosemia
0-20
E74.29
Other disorders of galactose metabolism
0-20
E74.4
Disorders of pyruvate metabolism and
								gluconeogenesis
0-20
E75.00
GM2 gangliosidosis, unspecified
0-20
E75.01
Sandhoff disease
0-20
E75.02
Tay-Sachs disease
0-20
E75.09
Other GM2 gangliosidosis
0-20
E75.10
Unspecified gangliosidosis
0-20
E75.11
Mucolipidosis IV
0-20
E75.19
Other gangliosidosis
0-20
E75.21
Fabry (-Anderson) disease
0-20
E75.22
Gaucher disease
0-20
E75.23
Krabbe disease
0-20
E75.242
Niemann-Pick disease type C
0-20
E75.243
Niemann-Pick disease type D
0-20
E75.244
Niemann-Pick disease type A/B
0-20
E75.25
Metachromatic leukodystrophy
0-20
E75.26
Sulfatase deficiency
0-20
E75.29
Other sphingolipidosis
0-20
E75.3
Sphingolipidosis, unspecified
0-20
E75.4
Neuronal ceroid lipofuscinosis
0-20
E75.5
Other lipid storage disorders
0-20
E76.01
Hurler's syndrome
0-64
E76.02
Hurler-Scheie syndrome
0-64
E76.03
Scheie's syndrome
0-64
E76.1
Mucopolysaccharidosis, type II
0-64
E76.210
Morquio A mucopolysaccharidoses
0-64
E76.211
Morquio B mucopolysaccharidoses
0-64
E76.219
Morquio mucopolysaccharidoses, unspecified
0-64
E76.22
Sanfilippo mucopolysaccharidoses
0-64
E76.29
Other mucopolysaccharidoses
0-64
E76.3
Mucopolysaccharidosis, unspecified
0-64
E76.8
Other disorders of glucosaminoglycan
								metabolism
0-64
E77.0
Defects in post-translational mod of lysosomal
								enzymes
0-20
E77.1
Defects in glycoprotein degradation
0-20
E77.8
Other disorders of glycoprotein metabolism
0-20
E79.1
Lesch-Nyhan syndrome
0-64
E79.2
Myoadenylate deaminase deficiency
0-64
E79.8
Other disorders of purine and pyrimidine
								metabolism
0-64
E79.9
Disorder of purine and pyrimidine metabolism,
								unspecified
0-64
E80.3
Defects of catalase and peroxidase
0-64
E84.0
Cystic fibrosis with pulmonary
								manifestations
0-64
E84.11
Meconium ileus in cystic fibrosis
0-64
E84.19
Cystic fibrosis with other intestinal
								manifestations
0-64
E84.8
Cystic fibrosis with other manifestations
0-64
E84.9
Cystic fibrosis, unspecified
0-64
E88.40
Mitochondrial metabolism disorder,
								unspecified
0-64
E88.41
MELAS syndrome
0-64
E88.42
MERRF syndrome
0-64
E88.49
Other mitochondrial metabolism disorders
0-64
E88.89
Other specified metabolic disorders
0-64
F84.2
Rett's syndrome
0-20
G11.0
Congenital nonprogressive ataxia
0-20
G11.10
Early-onset cerebellar ataxia, unspecified
0-20
G11.11
Friedreich ataxia
0-20
G11.19
Other early-onset cerebellar ataxia
0-20
G11.2
Late-onset cerebellar ataxia
0-20
G11.3
Cerebellar ataxia with defective DNA repair
0-20
G11.4
Hereditary spastic paraplegia
0-20
G11.8
Other hereditary ataxias
0-20
G11.9
Hereditary ataxia, unspecified
0-20
G12.0
Infantile spinal muscular atrophy, type I
								(Werdnig-Hoffman)
0-20
G12.1
Other inherited spinal muscular atrophy
0-20
G12.21
Amyotrophic lateral sclerosis
0-20
G12.22
Progressive bulbar palsy
0-20
G12.29
Other motor neuron disease
0-20
G12.8
Other spinal muscular atrophies and related
								syndromes
0-20
G12.9
Spinal muscular atrophy, unspecified
0-20
G24.1
Genetic torsion dystonia
0-64
G24.8
Other dystonia
0-64
G25.3
Myoclonus
0-5
G25.9
Extrapyramidal and movement disorder,
								unspecified
0-20
G31.81
Alpers disease
0-20
G31.82
Leigh's disease
0-20
G31.9
Degenerative disease of nervous system,
								unspecified
0-20
G32.81
Cerebellar ataxia in diseases classified
								elsewhere
0-20
G37.0
Diffuse sclerosis of central nervous system
0-64
G37.5
Concentric sclerosis (Balo) of central nervous
								system
0-64
G71.00
Muscular dystrophy, unspecified
0-64
G71.01
Duchenne or Becker muscular
								dystrophy
0-64
G71.02
Facioscapulohumeral muscular
								dystrophy
0-64
G71.031
Autosomal dominant limb girdle muscular
								dystrophy
0-64
G71.032
Autosomal recessive limb girdle muscular dystrophy
								due to calpain-3 dysfunction
0-64
G71.033
Limb girdle muscular dystrophy due to dysferlin
								dysfunction
0-64
G71.0340
Limb girdle muscular dystrophy due to sarcoglycan
								dysfunction, unspecified
0-64
G71.0341
Limb girdle muscular dystrophy due to alpha
								sarcoglycan dysfunction
0-64
G71.0342
Limb girdle muscular dystrophy due to beta
								sarcoglycan dysfunction
0-64
G71.0349
Limb girdle muscular dystrophy due to other
								sarcoglycan dysfunction
0-64
G71.035
Limb girdle muscular dystrophy due to anoctamin-5
								dysfunction
0-64
G71.038
Other limb girdle muscular dystrophy
0-64
G71.039
Limb girdle muscular dystrophy, unspecified
0-64
G71.09
Other specified muscular
								dystrophies
0-64
G71.11
Myotonic muscular dystrophy
0-64
G71.20
Congenital myopathy, unspecified
0-64
G71.21
Nemaline myopathy
0-64
G71.220
Centronuclear myopathy
0-64
G71.228
Other centronuclear myopathy
0-64
G71.29
Other congenital myopathy
0-64
G80.0
Spastic quadriplegic cerebral palsy
0-64
G80.1
Spastic diplegic cerebral palsy
0-20
G80.3
Athetoid cerebral palsy
0-64
G82.50
Quadriplegia, unspecified
0-64
G82.51
Quadriplegia, C1-C4 complete
0-64
G82.52
Quadriplegia, C1-C4 incomplete
0-64
G82.53
Quadriplegia, C5-C7 complete
0-64
G82.54
Quadriplegia, C5-C7 incomplete
0-64
G91.0
Communicating hydrocephalus
0-20
G91.1
Obstructive hydrocephalus
0-20
I67.5
Moyamoya disease
0-64
K91.2
Postsurgical malabsorption, not elsewhere
								classified
0-20
N03.A
Chronic nephritic syndrome with C3
								glomerulonephritis
0-20
N03.1
Chronic nephritic syndrome with focal and segmental
								glomerular lesions
0-20
N03.2
Chronic nephritic syndrome w diffuse membranous
								glomrlneph
0-20
N03.3
Chronic neph syndrome w diffuse mesangial prolif
								glomrlneph
0-20
N03.4
Chronic neph syndrome w diffuse endocaplry prolif
								glomrlneph
0-20
N03.5
Chronic nephritic syndrome w diffuse mesangiocap
								glomrlneph
0-20
N03.6
Chronic nephritic syndrome with dense deposit
								disease
0-20
N03.7
Chronic nephritic syndrome w diffuse crescentic
								glomrlneph
0-20
N03.8
Chronic nephritic syndrome with other morphologic
								changes
0-20
N03.9
Chronic nephritic syndrome with unsp morphologic
								changes
0-20
N08
Glomerular disorders in diseases classified
								elsewhere
0-20
N18.1
Chronic kidney disease, stage 1
0-20
N18.2
Chronic kidney disease, stage 2 (mild)
0-20
N18.30
Chronic kidney disease, stage 3, unspecified
0-20
N18.31
Chronic kidney disease, stage 3a
0-20
N18.32
Chronic kidney disease, stage 3b
0-20
N18.4
Chronic kidney disease, stage 4 (severe)
0-20
N18.5
Chronic kidney disease, stage 5
0-20
N18.6
End stage renal disease
0-20
N18.9
Chronic kidney disease, unspecified
0-20
Q01.9
Encephalocele, unspecified
0-20
Q02
Microcephaly
0-20
Q03.0
Malformations of aqueduct of Sylvius
0-20
Q03.1
Atresia of foramina of Magendie and Luschka
0-20
Q03.8
Other congenital hydrocephalus
0-20
Q03.9
Congenital hydrocephalus, unspecified
0-20
Q04.3
Other reduction deformities of
								brain
0-20
Q04.5
Megalencephaly
0-20
Q04.6
Congenital cerebral cysts
0-20
Q04.8
Other specified congenital malformations of
								brain
0-20
Q05.0
Cervical spina bifida with hydrocephalus
0-64
Q05.1
Thoracic spina bifida with hydrocephalus
0-64
Q05.2
Lumbar spina bifida with hydrocephalus
0-64
Q05.3
Sacral spina bifida with hydrocephalus
0--64
Q05.4
Unspecified spina bifida with hydrocephalus
0-64
Q05.5
Cervical spina bifida without hydrocephalus
0-64
Q05.6
Thoracic spina bifida without hydrocephalus
0-64
Q05.7
Lumbar spina bifida without hydrocephalus
0-64
Q05.8
Sacral spina bifida without hydrocephalus
0-64
Q05.9
Spina bifida, unspecified
0-64
Q06.0
Amyelia
0-64
Q06.1
Hypoplasia and dysplasia of spinal cord
0-64
Q06.2
Diastematomyelia
0-64
Q06.3
Other congenital cauda equina malformations
0-64
Q06.4
Hydromyelia
0-64
Q06.8
Other specified congenital malformations of spinal
								cord
0-64
Q07.01
Arnold-Chiari syndrome with spina bifida
0-64
Q07.02
Arnold-Chiari syndrome with hydrocephalus
0-64
Q07.03
Arnold-Chiari syndrome with spina bifida and
								hydrocephalus
0-64
Q30.1
Agenesis and underdevelopment of nose, cleft or
								absent nose only
0-5
Q30.2
Fissured, notched and cleft nose, cleft or absent
								nose only
0-5
Q31.0
Web of larynx
0-20
Q31.8
Other congenital malformations of larynx, atresia
								or agenesis of larynx only
0-20
Q32.1
Other congenital malformations of trachea, atresia
								or agenesis of trachea only
0-20
Q32.4
Other congenital malformations of bronchus, atresia
								or agenesis of bronchus only
0-20
Q33.0
Congenital cystic lung
0-20
Q33.2
Sequestration of lung
0-20
Q33.3
Agenesis of lung
0-20
Q33.6
Congenital hypoplasia and dysplasia of lung
0-20
Q35.1
Cleft hard palate
0-20
Q35.3
Cleft soft palate
0-20
Q35.5
Cleft hard palate with cleft soft palate
0-20
Q35.9
Cleft palate, unspecified
0-20
Q37.0
Cleft hard palate with bilateral cleft lip
0-20
Q37.1
Cleft hard palate with unilateral cleft lip
0-20
Q37.2
Cleft soft palate with bilateral cleft lip
0-20
Q37.3
Cleft soft palate with unilateral cleft lip
0-20
Q37.4
Cleft hard and soft palate with bilateral cleft
								lip
0-20
Q37.5
Cleft hard and soft palate with unilateral cleft
								lip
0-20
Q37.8
Unspecified cleft palate with bilateral cleft
								lip
0-20
Q37.9
Unspecified cleft palate with unilateral cleft
								lip
0-20
Q39.0
Atresia of esophagus without fistula
0-3
Q39.1
Atresia of esophagus with tracheo-esophageal
								fistula
0-3
Q39.2
Congenital tracheo-esophageal fistula without
								atresia
0-3
Q39.3
Congenital stenosis and stricture of
								esophagus
0-3
Q39.4
Esophageal web
0-3
Q42.0
Congenital absence, atresia and stenosis of rectum
								with fistula
0-5
Q42.1
Congen absence, atresia and stenosis of rectum
								without fistula
0-5
Q42.2
Congenital absence, atresia and stenosis of anus
								with fistula
0-5
Q42.3
Congenital absence, atresia and stenosis of anus
								without fistula
0-5
Q42.8
Congenital absence, atresia and stenosis of other
								parts of large intestine
0-5
Q42.9
Congenital absence, atresia and stenosis of large
								intestine, part unspecified
0-5
Q43.1
Hirschsprung's disease
0-15
Q44.2
Atresia of bile ducts
0-20
Q44.3
Congenital stenosis and stricture of bile
								ducts
0-20
Q44.6
Cystic disease of liver
0-20
Q45.0
Agenesis, aplasia and hypoplasia of pancreas
0-5
Q45.1
Annular pancreas
0-5
Q45.3
Other congenital malformations of pancreas and
								pancreatic duct
0-5
Q45.8
Other specified congenital malformations of
								digestive system
0-10
Q60.1
Renal agenesis, bilateral
0-20
Q60.4
Renal hypoplasia, bilateral
0-20
Q60.6
Potter's syndrome, with bilateral renal agenesis
								only
0-20
Q61.02
Congenital multiple renal cysts, bilateral
								only
0-20
Q61.19
Other polycystic kidney, infantile type, bilateral
								only
0-20
Q61.2
Polycystic kidney, adult type, bilateral
								only
0-20
Q61.3
Polycystic kidney, unspecified, bilateral
								only
0-20
Q61.4
Renal dysplasia, bilateral only
0-20
Q61.5
Medullary cystic kidney, bilateral only
0-20
Q61.9
Cystic kidney disease, unspecified, bilateral
								only
0-20
Q64.10
Exstrophy of urinary bladder, unspecified
0-20
Q64.12
Cloacal extrophy of urinary bladder
0-20
Q64.19
Other exstrophy of urinary bladder
0-20
Q75.0
Craniosynostosis
0-20
Q75.1
Craniofacial dysostosis
0-20
Q75.2
Hypertelorism
0-20
Q75.4
Mandibulofacial dysostosis
0-20
Q75.5
Oculomandibular dysostosis
0-20
Q75.8
Other congenital malformations of skull and face
								bones
0-20
Q77.4
Achondroplasia
0-1
Q77.6
Chondroectodermal dysplasia
0-1
Q77.8
Other osteochondrodysplasia with defects of growth
								of tubular bones and spine
0-1
Q78.0
Osteogenesis imperfecta
0-20
Q78.1
Polyostotic fibrous dysplasia
0-1
Q78.2
Osteopetrosis
0-1
Q78.3
Progressive diaphyseal dysplasia
0-1
Q78.4
Enchondromatosis
0-1
Q78.6
Multiple congenital exostoses
0-1
Q78.8
Other specified osteochondrodysplasias
0-1
Q78.9
Osteochondrodysplasia, unspecified
0-1
Q79.0
Congenital diaphragmatic hernia
0-1
Q79.1
Other congenital malformations of diaphragm
0-1
Q79.2
Exomphalos
0-1
Q79.3
Gastroschisis
0-1
Q79.4
Prune belly syndrome
0-1
Q79.59
Other congenital malformations of abdominal
								wall
0-1
Q89.7
Multiple congenital malformations, not elsewhere
								classified
0-10
R75
Inconclusive laboratory evidence of HIV
0-12 months
Z21
Asymptomatic human immunodeficiency virus infection
								status
0-20
Z99.11
Dependence on respirator (ventilator) status
1-64
Z99.2
Dependence on renal dialysis
21-64