M0076 HCPCS code: Prolotherapy
M0076 is the HCPCS Level II code for prolotherapy. Its Medicare coverage code is M (Non-covered by Medicare): Medicare does not cover this item or service.
Code details
| Field | Value |
|---|---|
| Section | M codes — Medical services and quality measures |
| Coverage code | M — Non-covered by Medicare |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | Y2 |
| Added | 1986-01-01 |
| Last action effective | 1996-01-01 |
Medicare policy articles for this code
- A57751: Billing and Coding: Trigger Point Injections (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B))
- A58282: Billing and Coding: Platelet Rich Plasma (Palmetto GBA (MAC - Part A, MAC - Part B))
- A58609: Billing and Coding: Platelet Rich Plasma (National Government Services, Inc. (MAC - Part A, MAC - Part B))
- A58737: Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A58788: Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A58808: Billing and Coding: Platelet Rich Plasma (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B))
- A58810: Billing and Coding: Platelet Rich Plasma (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B))
Covered diagnoses (36 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| M53.82 | Other specified dorsopathies, cervical region | 1 |
| M54.2 | Cervicalgia | 1 |
| M54.59 | Other low back pain | 1 |
| M54.6 | Pain in thoracic spine | 1 |
| M60.80 | Other myositis, unspecified site | 1 |
| M60.811 | Other myositis, right shoulder | 1 |
| M60.812 | Other myositis, left shoulder | 1 |
| M60.819 | Other myositis, unspecified shoulder | 1 |
| M60.821 | Other myositis, right upper arm | 1 |
| M60.822 | Other myositis, left upper arm | 1 |
Showing 10 of 36. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for M0076
- 1986-01-01: M0076 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code M0076?
M0076 is the HCPCS Level II code for prolotherapy. Short descriptor: "Prolotherapy".
Does Medicare cover M0076?
Coverage code M — Non-covered by Medicare. Medicare does not cover this item or service.
Which diagnoses support coverage for M0076?
Medicare policy articles that cite M0076 list 36 covered ICD-10-CM diagnosis codes across 7 articles. The most cited include M53.82 (Other specified dorsopathies, cervical region), M54.2 (Cervicalgia), M54.59 (Other low back pain). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Related M00 codes
- M0001 — Advancing cancer care mips value pathways
- M0002 — Optimal care for kidney health mips value pathways
- M0003 — Optimal care for patients with episodic neurological conditions mips value pathways
- M0004 — Quality care for patients with neurological conditions mips value pathway
- M0005 — Value in primary care mips value pathway
- M0010 — Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services
- M0064 — Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders
- M0075 — Cellular therapy
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under M0076
- Watch M0076 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for M0076
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.