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

ICD-10 M25.569

Billable / Specific

Pain in unspecified knee

M25
Block
0
Synonyms
43
LCDs
11
Payer Policies
2
Linked CPTs

About ICD-10-CM M25.569

ICD-10-CM code M25.569 represents Pain in unspecified knee. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M25). The 2026 edition of ICD-10-CM M25.569 became effective on October 1, 2025.

Medicare LCD Coverage for M25.569

Local Coverage Determinations (LCDs) from CMS MACs that list M25.569 as a covered diagnosis.

43 LCDs

Showing top 10 of 43 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
Article ID: 56607, Effective: 2025-10-01 00:00:00, 604 covered, 0 non-covered
CPT 64416 →
CMS LCD: Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
Article ID: 56607, Effective: 2025-10-01 00:00:00, 604 covered, 0 non-covered
CPT 64446 →
CMS LCD: Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
Article ID: 56607, Effective: 2025-10-01 00:00:00, 604 covered, 0 non-covered
CPT 64448 →
CMS LCD: Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
Article ID: 56607, Effective: 2025-10-01 00:00:00, 604 covered, 0 non-covered
CPT 64449 →
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 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M25.569.

11 policies

3 Cigna

Acupuncture - (CPG024)
Policy ID: CPG024_ACUPUNCTURE
Electrodiagnostic Testing (EMG/NCV) - (CPG129)
Policy ID: CPG129_EMG_NCV_SSEP
Peripheral Nerve Destruction for Pain Conditions - (0525) ---- future effective policy
Policy ID: MM_0525

5 Medicare

Billing and Coding: Zika Virus Testing by PCR and ELISA Methods
Policy ID: ART-55326
Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
Policy ID: ART-56607
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
Billing and Coding: Peripheral Nerve Blocks
Policy ID: ART-57788

3 Aetna

Magnetic Resonance Imaging (MRI) of the Extremities
Policy ID: CPB-0171
Autologous Chondrocyte Implantation
Policy ID: CPB-0247
Knee Arthroscopy / Osteoarthritis of the Knee
Policy ID: CPB-0673

CPT Codes Commonly Billed with M25.569

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

2 linkages
  • 86790 CMS LCD: Billing and Coding: Zika Virus Testing by PCR and ELISA Methods CMS LCD
  • 86794 CMS LCD: Billing and Coding: Zika Virus Testing by PCR and ELISA Methods CMS LCD

Convert M25.569 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
M25.569 71946 10000

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

ICD-10 M25.569, Billing FAQ

Is ICD-10 code M25.569 billable? +

Yes, M25.569 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 M25.569? +

Procedures frequently paired with M25.569 include: 86790, 86794.

What ICD-9 codes does M25.569 map to? +

Per CMS GEMs, M25.569 maps to ICD-9 codes: 71946. 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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