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ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 M12.311

Billable / Specific

Palindromic rheumatism, right shoulder

M12
Block
0
Synonyms
167
LCDs
3
Payer Policies
1
Linked CPTs

About ICD-10-CM M12.311

ICD-10-CM code M12.311 represents Palindromic rheumatism, right shoulder. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M12). The 2026 edition of ICD-10-CM M12.311 became effective on October 1, 2025.

Medicare LCD Coverage for M12.311

Local Coverage Determinations (LCDs) from CMS MACs that list M12.311 as a covered diagnosis.

167 LCDs

Showing top 10 of 167 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Chiropractic Services
Article ID: 56273, Effective: 2025-08-28 00:00:00, 315 covered, 0 non-covered
CPT 98942 →
CMS LCD: Billing and Coding: Chiropractic Services
Article ID: 56273, Effective: 2025-08-28 00:00:00, 315 covered, 0 non-covered
CPT 98940 →
CMS LCD: Billing and Coding: Chiropractic Services
Article ID: 56273, Effective: 2025-08-28 00:00:00, 315 covered, 0 non-covered
CPT 98941 →
CMS LCD: Billing and Coding: Chiropractic Services
Article ID: 56273, Effective: 2025-08-28 00:00:00, 315 covered, 0 non-covered
CPT 98943 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29131 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29260 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29580 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 97036 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29445 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 97542 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M12.311.

3 policies

3 Medicare

Billing and Coding: Outpatient Occupational Therapy
Policy ID: ART-53064
Billing and Coding: Outpatient Physical Therapy
Policy ID: ART-53065
Billing and Coding: Chiropractic Services
Policy ID: ART-56273

CPT Codes Commonly Billed with M12.311

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

1 linkages
  • 98943 CMS LCD: Billing and Coding: Chiropractic Services CMS LCD

Convert M12.311 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
M12.311 71931 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

Codes Adjacent To M12.311

Other codes in section M05-M14 (Inflammatory polyarthropathies).

M05 Rheumatoid arthritis with rheumatoid factor (non-billable) M05.0 Felty's syndrome (non-billable) M05.00 Felty's syndrome, unspecified site M05.01 Felty's syndrome, shoulder (non-billable) M05.011 Felty's syndrome, right shoulder M05.012 Felty's syndrome, left shoulder M05.019 Felty's syndrome, unspecified shoulder M05.02 Felty's syndrome, elbow (non-billable) M05.021 Felty's syndrome, right elbow M05.022 Felty's syndrome, left elbow M05.029 Felty's syndrome, unspecified elbow M05.03 Felty's syndrome, wrist (non-billable) M05.031 Felty's syndrome, right wrist M05.032 Felty's syndrome, left wrist M05.039 Felty's syndrome, unspecified wrist M05.04 Felty's syndrome, hand (non-billable) M05.041 Felty's syndrome, right hand M05.042 Felty's syndrome, left hand M05.049 Felty's syndrome, unspecified hand M05.05 Felty's syndrome, hip (non-billable)

ICD-10 M12.311, Billing FAQ

Is ICD-10 code M12.311 billable? +

Yes, M12.311 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What CPT codes are commonly billed with M12.311? +

Procedures frequently paired with M12.311 include: 98943.

What ICD-9 codes does M12.311 map to? +

Per CMS GEMs, M12.311 maps to ICD-9 codes: 71931. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on July 16, 2026.

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