M16.52: Unilateral post-traumatic osteoarthritis, left hip
M16.52, unilateral post-traumatic osteoarthritis, left hip, is listed as a covered diagnosis in 7 Medicare billing and coding articles that apply to 23 HCPCS Level II codes, including J0881 (Injection, darbepoetin alfa, 1 microgram (non-esrd use)), J0885 (Injection, epoetin alfa, (for non-esrd use), 1000 units), Q5106 (Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for…). The articles come from 4 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 M16.52 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | Special coverage instructions apply | — | 2 |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | Special coverage instructions apply | — | 2 |
| Q5106 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units | Special coverage instructions apply | — | 2 |
| J0882 | Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) | Special coverage instructions apply | — | 2 |
| J0888 | Injection, epoetin beta, 1 microgram, (for non esrd use) | Special coverage instructions apply | — | 2 |
| Q5105 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units | Special coverage instructions apply | — | 2 |
| J0887 | Injection, epoetin beta, 1 microgram, (for esrd on dialysis) | Special coverage instructions apply | — | 2 |
| J0890 | Injection, peginesatide, 0.1 mg (for esrd on dialysis) | Carrier judgment | — | 2 |
| Q4081 | Injection, epoetin alfa, 100 units (for esrd on dialysis) | Special coverage instructions apply | — | 2 |
| 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 | — | 3 |
| 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 | — | 2 |
| 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 | — | 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 |
| 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 |
| G2010 | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment | Carrier judgment | — | 1 |
| G2250 | Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment | Carrier judgment | — | 1 |
| G2251 | Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion | Carrier judgment | — | 1 |
| G0151 | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
| S2900 | Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure) | Not payable by Medicare | Not covered | 1 |
Medicare policy articles listing M16.52
- A58982: Billing and Coding: Erythropoiesis Stimulating Agents (Palmetto GBA (MAC - Part A, MAC - Part B); 9 Level II codes). LCD with the same title: L39237
- 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
- A60250: Billing and Coding: Total Joint Arthroplasty (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L33456, L36039, L39911, L40232
- 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
- A57311: Billing and Coding: Physical Therapy - Home Health (CGS Administrators, LLC (HHH MAC); 7 Level II codes). LCD with the same title: L33942
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 M16 diagnoses (Osteoarthritis of hip)
- M16.51 — Unilateral post-traumatic osteoarthritis, right hip
- M16.0 — Bilateral primary osteoarthritis of hip
- M16.11 — Unilateral primary osteoarthritis, right hip
- M16.12 — Unilateral primary osteoarthritis, left hip
- M16.2 — Bilateral osteoarthritis resulting from hip dysplasia
- M16.31 — Unilateral osteoarthritis resulting from hip dysplasia, right hip
- M16.32 — Unilateral osteoarthritis resulting from hip dysplasia, left hip
- M16.4 — Bilateral post-traumatic osteoarthritis of hip
- M16.6 — Other bilateral secondary osteoarthritis of hip
- M16.7 — Other unilateral secondary osteoarthritis of hip
Frequently asked questions
Does Medicare cover M16.52 (Unilateral post-traumatic osteoarthritis, left hip)?
Medicare covers items and services, not diagnoses. 7 Medicare billing and coding articles list M16.52 as a covered diagnosis for 23 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 M16.52?
The Level II codes from the policies most specific to this diagnosis are J0881 (Injection, darbepoetin alfa, 1 microgram (non-esrd use), 2 articles); J0885 (Injection, epoetin alfa, (for non-esrd use), 1000 units, 2 articles); Q5106 (Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for…, 2 articles); J0882 (Injection, darbepoetin alfa, 1 microgram (for esrd on…, 2 articles); J0888 (Injection, epoetin beta, 1 microgram, (for non esrd use), 2 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list M16.52?
A58982 (Billing and Coding: Erythropoiesis Stimulating Agents); A60381 (Billing and Coding: Erythropoiesis Stimulating Agents); A60250 (Billing and Coding: Total Joint Arthroplasty), and 4 more articles.
What is ICD-10-CM code M16.52?
M16.52 is the ICD-10-CM code for unilateral post-traumatic osteoarthritis, left hip, in category M16 (Osteoarthritis of hip), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under J0881
- Watch J0881 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0881
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