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

ICD-10 M75.111

Billable / Specific

Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic

M75
Block
0
Synonyms
342
LCDs
8
Payer Policies
1
Linked CPTs

About ICD-10-CM M75.111

ICD-10-CM code M75.111 represents Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M75). The 2026 edition of ICD-10-CM M75.111 became effective on October 1, 2025.

Medicare LCD Coverage for M75.111

Local Coverage Determinations (LCDs) from CMS MACs that list M75.111 as a covered diagnosis.

342 LCDs

Showing top 10 of 342 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
Article ID: 57079, Effective: 2026-01-01 00:00:00, 662 covered, 0 non-covered
CPT 26341 →
CMS LCD: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
Article ID: 57079, Effective: 2026-01-01 00:00:00, 662 covered, 0 non-covered
CPT 64632 →
CMS LCD: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
Article ID: 57079, Effective: 2026-01-01 00:00:00, 662 covered, 0 non-covered
CPT 64455 →
CMS LCD: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
Article ID: 57079, Effective: 2026-01-01 00:00:00, 662 covered, 0 non-covered
CPT 20526 →
CMS LCD: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
Article ID: 57079, Effective: 2026-01-01 00:00:00, 662 covered, 0 non-covered
CPT 20612 →
CMS LCD: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
Article ID: 57079, Effective: 2026-01-01 00:00:00, 662 covered, 0 non-covered
CPT 20527 →
CMS LCD: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
Article ID: 57079, Effective: 2026-01-01 00:00:00, 662 covered, 0 non-covered
CPT 28899 →
CMS LCD: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
Article ID: 57079, Effective: 2026-01-01 00:00:00, 662 covered, 0 non-covered
CPT 20550 →
CMS LCD: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
Article ID: 57079, Effective: 2026-01-01 00:00:00, 662 covered, 0 non-covered
CPT 20551 →
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 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M75.111.

8 policies

1 Cigna

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

5 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
Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
Policy ID: ART-57079

CPT Codes Commonly Billed with M75.111

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

1 linkages
  • 23472 CMS LCD: Billing and Coding: Total Shoulder Arthroplasty CMS LCD

Convert M75.111 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
M75.111 72613 10000

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

ICD-10 M75.111, Billing FAQ

Is ICD-10 code M75.111 billable? +

Yes, M75.111 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 M75.111? +

Procedures frequently paired with M75.111 include: 23472.

What ICD-9 codes does M75.111 map to? +

Per CMS GEMs, M75.111 maps to ICD-9 codes: 72613. 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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