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

ICD-10 M12.569

Billable / Specific

Traumatic arthropathy, unspecified knee

M12
Block
0
Synonyms
16
LCDs
3
Payer Policies
0
Linked CPTs

About ICD-10-CM M12.569

ICD-10-CM code M12.569 represents Traumatic arthropathy, unspecified knee. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M12). The 2026 edition of ICD-10-CM M12.569 became effective on October 1, 2025.

Medicare LCD Coverage for M12.569

Local Coverage Determinations (LCDs) from CMS MACs that list M12.569 as a covered diagnosis.

16 LCDs

Showing top 10 of 16 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27134 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27130 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27487 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27137 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27486 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27138 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27132 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27447 →
CMS LCD: Billing and Coding: Major Joint Replacement (Hip and Knee)
Article ID: 57765, Effective: 2026-01-01 00:00:00, 2372 covered, 1 non-covered
CPT 27134 →
CMS LCD: Billing and Coding: Major Joint Replacement (Hip and Knee)
Article ID: 57765, Effective: 2026-01-01 00:00:00, 2372 covered, 1 non-covered
CPT 27130 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M12.569.

3 policies

1 Cigna

Peripheral Nerve Destruction for Pain Conditions - (0525) ---- future effective policy
Policy ID: MM_0525

2 Medicare

Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Policy ID: ART-56796
Billing and Coding: Major Joint Replacement (Hip and Knee)
Policy ID: ART-57765

CPT Codes Commonly Billed with M12.569

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

No procedure linkages on file for M12.569

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert M12.569 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
M12.569 71616 10000

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

Codes Adjacent To M12.569

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 M12.569, Billing FAQ

Is ICD-10 code M12.569 billable? +

Yes, M12.569 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What ICD-9 codes does M12.569 map to? +

Per CMS GEMs, M12.569 maps to ICD-9 codes: 71616. 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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