ICD-10 M96.6
Non-Billable HeaderFracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate
About ICD-10-CM M96.6
ICD-10-CM code M96.6 represents Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate. This is a non-billable header code in the Musculoskeletal and Connective Tissue chapter (block M96). The 2026 edition of ICD-10-CM M96.6 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 M96.6. Per CMS ICD-10-CM Tabular 2026.
- Intraoperative fracture of bone during insertion of orthopedic implant, joint prosthesis, or bone plate
Type 2 Excludes
Not included here, the excluded code is not part of M96.6, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- complication of internal orthopedic devices, implants or grafts (T84.-)
Medicare LCD Coverage for M96.6
Local Coverage Determinations (LCDs) from CMS MACs that list M96.6 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 M96.6.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but M96.6 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with M96.6
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
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.
Codes Adjacent To M96.6
Other codes in section M96 (Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified).
ICD-10 M96.6, Billing FAQ
Is ICD-10 code M96.6 billable? +
No, M96.6 is a non-billable header code. Use a more specific child code from block M96 when submitting claims.
What other names or terms map to M96.6? +
ICD-10 M96.6 includes: Intraoperative fracture of bone during insertion of orthopedic implant, joint prosthesis, or bone plate.
What codes are Type 2 Excludes for M96.6? +
Type 2 Excludes (may be coded together when both conditions exist): complication of internal orthopedic devices, implants or grafts (T84.-)
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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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