M06.242: Rheumatoid bursitis, left hand
M06.242, rheumatoid bursitis, left hand, is listed as a covered diagnosis in 11 Medicare billing and coding articles that apply to 31 HCPCS Level II codes, including J9312 (Injection, rituximab, 10 mg), Q5123 (Injection, rituximab-arrx, biosimilar, (riabni), 10 mg), Q5119 (Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg). The articles come from 5 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 M06.242 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J9312 | Injection, rituximab, 10 mg | Special coverage instructions apply | — | 3 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | Carrier judgment | — | 3 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | Carrier judgment | — | 3 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | Special coverage instructions apply | — | 3 |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | Special coverage instructions apply | — | 3 |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | Special coverage instructions apply | — | 3 |
| Q5106 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units | Special coverage instructions apply | — | 3 |
| J0882 | Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) | Special coverage instructions apply | — | 3 |
| Q5105 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units | Special coverage instructions apply | — | 3 |
| J0890 | Injection, peginesatide, 0.1 mg (for esrd on dialysis) | Carrier judgment | — | 3 |
| Q4081 | Injection, epoetin alfa, 100 units (for esrd on dialysis) | Special coverage instructions apply | — | 3 |
| J0888 | Injection, epoetin beta, 1 microgram, (for non esrd use) | Special coverage instructions apply | — | 2 |
| J0887 | Injection, epoetin beta, 1 microgram, (for esrd on dialysis) | Special coverage instructions apply | — | 2 |
| 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 |
| 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 |
| G0127 | Trimming of dystrophic nails, any number | Special coverage instructions apply | — | 1 |
| J9311 | Injection, rituximab 10 mg and hyaluronidase | Special coverage instructions apply | — | 1 |
| J3590 | Unclassified biologics | Carrier judgment | — | 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 |
| A9585 | Injection, gadobutrol, 0.1 ml | Carrier judgment | — | 1 |
| Q9953 | Injection, iron-based magnetic resonance contrast agent, per ml | Special coverage instructions apply | — | 1 |
6 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing M06.242
- A56795: Billing and Coding: Erythropoiesis Stimulating Agents (ESAs) (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 9 Level II codes). LCD with the same title: L34633
- A55639: Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 6 Level II codes)
- A52423: Billing and Coding: Infliximab and biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B); 4 Level II codes)
- A57193: Billing and Coding: Routine Foot Care and Debridement of Nails (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L33636, L34246
- A56380: Billing and Coding: Rituximab (Palmetto GBA (MAC - Part A, MAC - Part B); 6 Level II codes). LCD with the same title: L35026
- A59101: Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B); 4 Level II codes). LCD with the same title: L38920, L39297
- A56462: Billing and Coding: Erythropoiesis Stimulating Agents (ESA) (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 7 Level II codes). LCD with the same title: L34356
- A60381: Billing and Coding: Erythropoiesis Stimulating Agents (Wellpoint Federal (MAC - Part A, MAC - Part B); 9 Level II codes). LCD with the same title: L39237
- A57206: Billing and Coding: Lumbar MRI (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L34220
- 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 M06 diagnoses (Other rheumatoid arthritis)
- M06.241 — Rheumatoid bursitis, right hand
- M06.211 — Rheumatoid bursitis, right shoulder
- M06.212 — Rheumatoid bursitis, left shoulder
- M06.221 — Rheumatoid bursitis, right elbow
- M06.222 — Rheumatoid bursitis, left elbow
- M06.231 — Rheumatoid bursitis, right wrist
- M06.232 — Rheumatoid bursitis, left wrist
- M06.251 — Rheumatoid bursitis, right hip
- M06.252 — Rheumatoid bursitis, left hip
- M06.261 — Rheumatoid bursitis, right knee
- M06.262 — Rheumatoid bursitis, left knee
- M06.271 — Rheumatoid bursitis, right ankle and foot
- M06.272 — Rheumatoid bursitis, left ankle and foot
- M06.28 — Rheumatoid bursitis, vertebrae
- M06.29 — Rheumatoid bursitis, multiple sites
- M06.00 — Rheumatoid arthritis without rheumatoid factor, unspecified site
- M06.011 — Rheumatoid arthritis without rheumatoid factor, right shoulder
- M06.012 — Rheumatoid arthritis without rheumatoid factor, left shoulder
- M06.019 — Rheumatoid arthritis without rheumatoid factor, unspecified shoulder
- M06.021 — Rheumatoid arthritis without rheumatoid factor, right elbow
- M06.022 — Rheumatoid arthritis without rheumatoid factor, left elbow
- M06.029 — Rheumatoid arthritis without rheumatoid factor, unspecified elbow
- M06.031 — Rheumatoid arthritis without rheumatoid factor, right wrist
- M06.032 — Rheumatoid arthritis without rheumatoid factor, left wrist
- M06.039 — Rheumatoid arthritis without rheumatoid factor, unspecified wrist
- M06.041 — Rheumatoid arthritis without rheumatoid factor, right hand
- M06.042 — Rheumatoid arthritis without rheumatoid factor, left hand
- M06.049 — Rheumatoid arthritis without rheumatoid factor, unspecified hand
- M06.051 — Rheumatoid arthritis without rheumatoid factor, right hip
- M06.052 — Rheumatoid arthritis without rheumatoid factor, left hip
Frequently asked questions
Does Medicare cover M06.242 (Rheumatoid bursitis, left hand)?
Medicare covers items and services, not diagnoses. 11 Medicare billing and coding articles list M06.242 as a covered diagnosis for 31 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 M06.242?
The Level II codes from the policies most specific to this diagnosis are J9312 (Injection, rituximab, 10 mg, 3 articles); Q5123 (Injection, rituximab-arrx, biosimilar, (riabni), 10 mg, 3 articles); Q5119 (Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg, 3 articles); Q5115 (Injection, rituximab-abbs, biosimilar, (truxima), 10 mg, 3 articles); J0881 (Injection, darbepoetin alfa, 1 microgram (non-esrd use), 3 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list M06.242?
A56795 (Billing and Coding: Erythropoiesis Stimulating Agents (ESAs)); A55639 (Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions); A52423 (Billing and Coding: Infliximab and biosimilars), and 8 more articles.
What is ICD-10-CM code M06.242?
M06.242 is the ICD-10-CM code for rheumatoid bursitis, left hand, in category M06 (Other rheumatoid arthritis), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under J9312
- Watch J9312 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9312
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