ICD-10 S43
Non-Billable HeaderDislocation and sprain of joints and ligaments of shoulder girdle
About ICD-10-CM S43
ICD-10-CM code S43 represents Dislocation and sprain of joints and ligaments of shoulder girdle. This is a non-billable header code in the Injury, Poisoning, and External Causes chapter (block S43). The 2026 edition of ICD-10-CM S43 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.
Coding Tips for S43
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Injury codes require a 7th character: A (initial encounter, active treatment), D (subsequent, healing/recovery), S (sequela, late effect of original injury). Codes with fewer than 6 characters need the placeholder X to bring them to 6 characters before adding the 7th. Wrong or missing 7th character is the #1 cause of injury claim denials.
Type 2 Excludes
Not included here, the excluded code is not part of S43, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- strain of muscle, fascia and tendon of shoulder and upper arm (S46.-)
Includes
- avulsion of joint or ligament of shoulder girdle
- laceration of cartilage, joint or ligament of shoulder girdle
- sprain of cartilage, joint or ligament of shoulder girdle
- traumatic hemarthrosis of joint or ligament of shoulder girdle
- traumatic rupture of joint or ligament of shoulder girdle
- traumatic subluxation of joint or ligament of shoulder girdle
- traumatic tear of joint or ligament of shoulder girdle
Coding Notes
Code Also
- any associated open wound
Seven Chr Note
- The appropriate 7th character is to be added to each code from category S43
Medicare LCD Coverage for S43
Local Coverage Determinations (LCDs) from CMS MACs that list S43 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 S43.
1 Humana Medicare Advantage
CPT Codes Commonly Billed with S43
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 S43
Other codes in section S40-S49 (Injuries to the shoulder and upper arm).
ICD-10 S43, Billing FAQ
Is ICD-10 code S43 billable? +
No, S43 is a non-billable header code. Use a more specific child code from block S43 when submitting claims.
What codes are Type 2 Excludes for S43? +
Type 2 Excludes (may be coded together when both conditions exist): strain of muscle, fascia and tendon of shoulder and upper arm (S46.-)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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