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

ICD-10 M13.811

Billable / Specific

Other specified arthritis, right shoulder

M13
Block
0
Synonyms
282
LCDs
5
Payer Policies
0
Linked CPTs

About ICD-10-CM M13.811

ICD-10-CM code M13.811 represents Other specified arthritis, right shoulder. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M13). The 2026 edition of ICD-10-CM M13.811 became effective on October 1, 2025.

Medicare LCD Coverage for M13.811

Local Coverage Determinations (LCDs) from CMS MACs that list M13.811 as a covered diagnosis.

282 LCDs

Showing top 10 of 282 total . Click a CPT for full coverage scope.

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 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 97110 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 97533 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29130 →
CMS LCD: Billing and Coding: Outpatient Physical Therapy
Article ID: 53065, Effective: 2026-01-01 00:00:00, 22208 covered, 0 non-covered
CPT 29405 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M13.811.

5 policies

1 Cigna

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

4 Medicare

Billing and Coding: Home Health Occupational Therapy
Policy ID: ART-53057
Billing and Coding: Home Health Physical Therapy
Policy ID: ART-53058
Billing and Coding: Outpatient Occupational Therapy
Policy ID: ART-53064
Billing and Coding: Outpatient Physical Therapy
Policy ID: ART-53065

CPT Codes Commonly Billed with M13.811

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

No procedure linkages on file for M13.811

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 M13.811 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
M13.811 71621 10000

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

Codes Adjacent To M13.811

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 M13.811, Billing FAQ

Is ICD-10 code M13.811 billable? +

Yes, M13.811 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What ICD-9 codes does M13.811 map to? +

Per CMS GEMs, M13.811 maps to ICD-9 codes: 71621. 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 May 31, 2026.

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