ICD-10 M16.1
Non-Billable HeaderUnilateral primary osteoarthritis of hip
About ICD-10-CM M16.1
ICD-10-CM code M16.1 represents Unilateral primary osteoarthritis of hip. This is a non-billable header code in the Musculoskeletal and Connective Tissue chapter (block M16). The 2026 edition of ICD-10-CM M16.1 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under M16.1. Per CMS ICD-10-CM Tabular 2026.
- Primary osteoarthritis of hip NOS
Medicare LCD Coverage for M16.1
Local Coverage Determinations (LCDs) from CMS MACs that list M16.1 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing M16.1.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but M16.1 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
Codes Adjacent To M16.1
Other codes in section M15-M19 (Osteoarthritis).
ICD-10 M16.1, Billing FAQ
Is ICD-10 code M16.1 billable? +
No, M16.1 is a non-billable header code. Use a more specific child code from block M16 when submitting claims.
What other names or terms map to M16.1? +
ICD-10 M16.1 includes: Primary osteoarthritis of hip NOS.
What CPT codes are commonly billed with M16.1? +
Procedures frequently paired with M16.1 include: 27430, 27446.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team