ICD-10 S49
Non-Billable HeaderOther and unspecified injuries of shoulder and upper arm
About ICD-10-CM S49
ICD-10-CM code S49 represents Other and unspecified injuries of shoulder and upper arm. This is a non-billable header code in the Injury, Poisoning, and External Causes chapter (block S49). The 2026 edition of ICD-10-CM S49 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 S49
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.
Coding Notes
Seven Chr Note
- The appropriate 7th character is to be added to each code from subcategories S49.0 and S49.1
Medicare LCD Coverage for S49
Local Coverage Determinations (LCDs) from CMS MACs that list S49 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 S49.
1 Aetna
4 Cigna
CPT Codes Commonly Billed with S49
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 S49
Other codes in section S40-S49 (Injuries to the shoulder and upper arm).
ICD-10 S49, Billing FAQ
Is ICD-10 code S49 billable? +
No, S49 is a non-billable header code. Use a more specific child code from block S49 when submitting claims.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team