ICD-10 M97
Non-Billable HeaderPeriprosthetic fracture around internal prosthetic joint
About ICD-10-CM M97
ICD-10-CM code M97 represents Periprosthetic fracture around internal prosthetic joint. This is a non-billable header code in the Musculoskeletal and Connective Tissue chapter (block M97). The 2026 edition of ICD-10-CM M97 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.
Type 2 Excludes
Not included here, the excluded code is not part of M97, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6-)
- breakage (fracture) of prosthetic joint (T84.01-)
Coding Notes
Code First
- , if known, the specific type and cause of fracture, such as traumatic or pathological
Seven Chr Note
- The appropriate 7th character is to be added to each code from category M97
Medicare LCD Coverage for M97
Local Coverage Determinations (LCDs) from CMS MACs that list M97 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 M97.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but M97 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with M97
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 M97
Other codes in section M97 (Periprosthetic fracture around internal prosthetic joint).
ICD-10 M97, Billing FAQ
Is ICD-10 code M97 billable? +
No, M97 is a non-billable header code. Use a more specific child code from block M97 when submitting claims.
What codes are Type 2 Excludes for M97? +
Type 2 Excludes (may be coded together when both conditions exist): fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6-); breakage (fracture) of prosthetic joint (T84.01-)
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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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