M16 — ICD-10-CM category M16

Code definition & billing validity

Coding context for M16

Osteoarthritis of the hip falls under Chapter XIII — Diseases of the musculoskeletal system. MAC LCDs specify medical necessity documentation for hip arthroplasty and conservative treatment requirements.

Source: CDC ICD-10-CM Tabular List · CMS National Coverage Analysis

Coverage check · verified

Which Medicare LCDs cover M16, by MAC?

The LCDs whose CMS Billing & Coding article lists M16as covered or non-covered — each jurisdiction, effective-dated, linked to the government document. No guesses; if a policy isn’t on file we say so.

MAC coverage considerations

Local Coverage Determinations (LCDs) from Medicare Administrative Contractors may impose medical necessity requirements for services billed with M16. Coverage criteria vary by MAC jurisdiction. Every contractor publishes its LCDs to the CMS Medicare Coverage Database, and CLV Intelligence tracks that database daily for LCD updates affecting this code and related codes.

MAC jurisdiction coverage

All seven Medicare Administrative Contractors (MACs) are monitored daily for LCD revisions, billing guidance, and coverage policy updates affecting ICD-10-CM M16.

Related ICD-10-CM codes & category

Frequently asked

What are the active CMS reimbursement alerts for ICD-10-CM code M16?

According to CLV Intelligence data, no CMS policy changes are currently matched to ICD-10-CM code M16 (ICD-10-CM category M16). Federal Register, LCD, and MAC contractor publications are monitored daily.

Which MAC contractors publish LCD or billing guidance for M16?

According to CLV Intelligence data, Local Coverage Determinations (LCDs) and billing guidance relevant to ICD-10-CM code M16 (ICD-10-CM category M16) may be issued by any of the seven Medicare Administrative Contractors (MACs): Noridian Healthcare Solutions (Jurisdictions E and F), CGS Administrators (Jurisdiction 15), Palmetto GBA (Jurisdictions J and M), NGS (Jurisdictions 6 and K), WPS Government Health Administrators (Jurisdictions 5 and 8), First Coast Service Options (Jurisdiction N), and Novitas Solutions (Jurisdictions H and L). CLV Intelligence monitors all MAC jurisdictions daily and surfaces alerts by jurisdiction so clinical coders can filter to their region.

Is ICD-10-CM code M16 billable under Medicare in 2025–2026?

ICD-10-CM code M16 — ICD-10-CM category M16 — is a valid billable diagnosis code under the ICD-10-CM FY2026 code set maintained by the Centers for Disease Control and Prevention (CDC) and adopted by CMS for Medicare and Medicaid billing. CLV Intelligence tracks CMS fee schedule updates, LCD revisions, and coverage policy changes that may affect reimbursement eligibility for this code. Coders should verify against the most recent MAC LCD and CMS NCCI edits before submission.

Get notified when CMS or MAC policy changes affect M16

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