M25.361 — Other instability, right knee

Code definition & billing validity

Coverage check · verified

Which Medicare LCDs cover M25.361, by MAC?

The LCDs whose CMS Billing & Coding article lists M25.361as 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 M25.361. 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 M25.361.

Related ICD-10-CM codes & category

Frequently asked

What are the active CMS reimbursement alerts for ICD-10-CM code M25.361?

According to CLV Intelligence data, 1 active CMS and MAC reimbursement policy changes are matched to ICD-10-CM code M25.361 (Other instability, right knee) by CLV analysis of each policy. Policies are sourced from CMS transmittals, Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCDs), and Federal Register notices; the linked source document is authoritative. Data is updated daily.

Which MAC contractors publish LCD or billing guidance for M25.361?

According to CLV Intelligence data, Local Coverage Determinations (LCDs) and billing guidance relevant to ICD-10-CM code M25.361 (Other instability, right knee) 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 M25.361 billable under Medicare in 2025–2026?

ICD-10-CM code M25.361 — Other instability, right knee — 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.

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