M02.311: Reiter's disease, right shoulder
M02.311, Reiter's disease, right shoulder, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 17 HCPCS Level II codes, including J1745 (Injection, infliximab, excludes biosimilar, 10 mg), Q5104 (Injection, infliximab-abda, biosimilar, (renflexis), 10 mg), Q5103 (Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg). The articles come from 2 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with M02.311 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | Special coverage instructions apply | — | 1 |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | Special coverage instructions apply | — | 1 |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | Special coverage instructions apply | — | 1 |
| Q5121 | Injection, infliximab-axxq, biosimilar, (avsola), 10 mg | Carrier judgment | — | 1 |
| J9312 | Injection, rituximab, 10 mg | Special coverage instructions apply | — | 1 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | Carrier judgment | — | 1 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | Carrier judgment | — | 1 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | Special coverage instructions apply | — | 1 |
| J9260 | Injection, methotrexate sodium, 50 mg | Special coverage instructions apply | — | 1 |
| J9215 | Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu | Special coverage instructions apply | — | 1 |
| G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | Carrier judgment | — | 2 |
| G0152 | Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
| G0158 | Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
| G0160 | Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes | Carrier judgment | — | 1 |
| G2169 | Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes | Carrier judgment | — | 1 |
| G0281 | Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care | Carrier judgment | — | 1 |
| G0329 | Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care | Carrier judgment | — | 1 |
Medicare policy articles listing M02.311
- A56432: Billing and Coding: Infliximab (Palmetto GBA (MAC - Part A, MAC - Part B); 4 Level II codes). LCD with the same title: L35677
- A55639: Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 6 Level II codes)
- A53057: Billing and Coding: Home Health Occupational Therapy (Palmetto GBA (HHH MAC); 5 Level II codes). LCD with the same title: L34560
- A53064: Billing and Coding: Outpatient Occupational Therapy (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34427
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other M02 diagnoses (Postinfective and reactive arthropathies)
- M02.312 — Reiter's disease, left shoulder
- M02.321 — Reiter's disease, right elbow
- M02.322 — Reiter's disease, left elbow
- M02.331 — Reiter's disease, right wrist
- M02.332 — Reiter's disease, left wrist
- M02.341 — Reiter's disease, right hand
- M02.342 — Reiter's disease, left hand
- M02.351 — Reiter's disease, right hip
- M02.352 — Reiter's disease, left hip
- M02.361 — Reiter's disease, right knee
- M02.362 — Reiter's disease, left knee
- M02.371 — Reiter's disease, right ankle and foot
- M02.372 — Reiter's disease, left ankle and foot
- M02.38 — Reiter's disease, vertebrae
- M02.39 — Reiter's disease, multiple sites
- M02.811 — Other reactive arthropathies, right shoulder
- M02.812 — Other reactive arthropathies, left shoulder
- M02.831 — Other reactive arthropathies, right wrist
- M02.832 — Other reactive arthropathies, left wrist
- M02.841 — Other reactive arthropathies, right hand
- M02.842 — Other reactive arthropathies, left hand
- M02.851 — Other reactive arthropathies, right hip
- M02.852 — Other reactive arthropathies, left hip
- M02.861 — Other reactive arthropathies, right knee
- M02.862 — Other reactive arthropathies, left knee
- M02.871 — Other reactive arthropathies, right ankle and foot
- M02.872 — Other reactive arthropathies, left ankle and foot
- M02.88 — Other reactive arthropathies, vertebrae
- M02.89 — Other reactive arthropathies, multiple sites
Frequently asked questions
Does Medicare cover M02.311 (Reiter's disease, right shoulder)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list M02.311 as a covered diagnosis for 17 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 M02.311?
The Level II codes from the policies most specific to this diagnosis are J1745 (Injection, infliximab, excludes biosimilar, 10 mg, 1 article); Q5104 (Injection, infliximab-abda, biosimilar, (renflexis), 10 mg, 1 article); Q5103 (Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg, 1 article); Q5121 (Injection, infliximab-axxq, biosimilar, (avsola), 10 mg, 1 article); J9312 (Injection, rituximab, 10 mg, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list M02.311?
A56432 (Billing and Coding: Infliximab); A55639 (Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions); A53057 (Billing and Coding: Home Health Occupational Therapy), and 1 more article.
What is ICD-10-CM code M02.311?
M02.311 is the ICD-10-CM code for Reiter's disease, right shoulder, in category M02 (Postinfective and reactive arthropathies), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under J1745
- Watch J1745 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1745
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 13: Diseases of the musculoskeletal system and connective tissue · All diagnoses · HCPCS lookup