M06.4: Inflammatory polyarthropathy

M06.4, inflammatory polyarthropathy, is listed as a covered diagnosis in 5 Medicare billing and coding articles that apply to 28 HCPCS Level II codes, including J1569 (Injection, immune globulin, (gammagard liquid/gammagard…), J1561 (Injection, immune globulin, (gamunex-c/gammaked)…), J1459 (Injection, immune globulin (privigen), intravenous…). The articles come from 3 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 M06.4 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
J1569Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mgSpecial coverage instructions apply—1
J1561Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mgSpecial coverage instructions apply—1
J1459Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—1
J1576Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mgSpecial coverage instructions apply—1
J1557Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—1
J1556Injection, immune globulin (bivigam), 500 mgCarrier judgment—1
J1568Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mgCarrier judgment—1
J1566Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mgSpecial coverage instructions apply—1
J1554Injection, immune globulin (asceniv), 500 mgCarrier judgment—1
J1599Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mgCarrier judgment—1
J1577Injection, immune globulin (qivigy), 100 mgCarrier judgment—1
J1745Injection, infliximab, excludes biosimilar, 10 mgSpecial coverage instructions apply—1
Q5104Injection, infliximab-abda, biosimilar, (renflexis), 10 mgSpecial coverage instructions apply—1
Q5103Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mgSpecial coverage instructions apply—1
Q5121Injection, infliximab-axxq, biosimilar, (avsola), 10 mgCarrier judgment—1
J9312Injection, rituximab, 10 mgSpecial coverage instructions apply—1
Q5123Injection, rituximab-arrx, biosimilar, (riabni), 10 mgCarrier judgment—1
Q5119Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mgCarrier judgment—1
Q5115Injection, rituximab-abbs, biosimilar, (truxima), 10 mgSpecial coverage instructions apply—1
J9260Injection, methotrexate sodium, 50 mgSpecial coverage instructions apply—1
J9215Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iuSpecial coverage instructions apply—1
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of careCarrier judgment—2
G0152Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutesCarrier judgment—1
G0158Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutesCarrier judgment—1
G0160Services 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 minutesCarrier judgment—1

3 more codes are listed. See every code with payment by region in Caduvo.

Medicare policy articles listing M06.4

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)

Frequently asked questions

Does Medicare cover M06.4 (Inflammatory polyarthropathy)?

Medicare covers items and services, not diagnoses. 5 Medicare billing and coding articles list M06.4 as a covered diagnosis for 28 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 M06.4?

The Level II codes from the policies most specific to this diagnosis are J1569 (Injection, immune globulin, (gammagard liquid/gammagard…, 1 article); J1561 (Injection, immune globulin, (gamunex-c/gammaked)…, 1 article); J1459 (Injection, immune globulin (privigen), intravenous…, 1 article); J1576 (Injection, immune globulin (panzyga), intravenous…, 1 article); J1557 (Injection, immune globulin, (gammaplex), intravenous…, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list M06.4?

A59105 (Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)); A56432 (Billing and Coding: Infliximab); A55639 (Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions), and 2 more articles.

What is ICD-10-CM code M06.4?

M06.4 is the ICD-10-CM code for inflammatory polyarthropathy, in category M06 (Other rheumatoid arthritis), chapter 13: Diseases of the musculoskeletal system and connective tissue.

Next steps

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