ICD-10 M97.8
Non-Billable HeaderPeriprosthetic fracture around other internal prosthetic joint
About ICD-10-CM M97.8
ICD-10-CM code M97.8 represents Periprosthetic fracture around other 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 M97.8 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 M97.8. Per CMS ICD-10-CM Tabular 2026.
- Periprosthetic fracture around internal prosthetic finger joint
- Periprosthetic fracture around internal prosthetic spinal joint
- Periprosthetic fracture around internal prosthetic toe joint
- Periprosthetic fracture around internal prosthetic wrist joint
Use Additional Code
When coding M97.8, also report these additional codes when applicable.
- code to identify the joint (Z96.6-)
Medicare LCD Coverage for M97.8
Local Coverage Determinations (LCDs) from CMS MACs that list M97.8 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 M97.8.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but M97.8 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with M97.8
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 M97.8
Other codes in section M97 (Periprosthetic fracture around internal prosthetic joint).
ICD-10 M97.8, Billing FAQ
Is ICD-10 code M97.8 billable? +
No, M97.8 is a non-billable header code. Use a more specific child code from block M97 when submitting claims.
What other names or terms map to M97.8? +
ICD-10 M97.8 includes: Periprosthetic fracture around internal prosthetic finger joint; Periprosthetic fracture around internal prosthetic spinal joint; Periprosthetic fracture around internal prosthetic toe joint, and 1 more clinical synonyms.
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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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