Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0 (FY2026), Appendix B.

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Code Set: Valid FY2026 and FY2027. FY2026 took effect October 1, 2025.

Official Registry Overview & Definition

Encounter for prophylactic removal of breast is a billable ICD-10-CM diagnosis code (Z40.01).

Sequencing, inclusion, and exclusion notes published for Z40.01 in the official ICD-10-CM tabular list.

Conditions that can never be reported with this code; the two are mutually exclusive.

Conditions not covered by this code, but which may be reported alongside it when both are present.

Supplementary codes the tabular list directs you to add.

Use additional code to identify risk factor, such as genetic susceptibility to malignant neoplasm Z15.-

Official ICD-10-CM classifications closest to Z40.01 in its code family, with their registry titles.

Z40 — Encounter for prophylactic surgery
Z40.0 — Encounter for prophylactic surgery for risk factors related to malignant neoplasms
Z40.00 — Encounter for prophylactic removal of unspecified organ
Z40.02 — Encounter for prophylactic removal of ovary(s)
Z40.03 — Encounter for prophylactic removal of fallopian tube(s)
Z40.09 — Encounter for prophylactic removal of other organ
Z40.8 — Encounter for other prophylactic surgery
Z40.81 — Encounter for prophylactic surgery for removal of ovary(s) for persons without known genetic/familial risk factors
Z40.82 — Encounter for prophylactic surgery for removal of fallopian tube(s) for persons without known genetic/familial risk factors
Z40.89 — Encounter for other prophylactic surgery

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code.