M19.111: Post-traumatic osteoarthritis, right shoulder
M19.111, post-traumatic osteoarthritis, right shoulder, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 24 HCPCS Level II codes, including J7328 (Hyaluronan or derivative, gelsyn-3, for intra-articular…), J7318 (Hyaluronan or derivative, durolane, for intra-articular…), J7325 (Hyaluronan or derivative, synvisc or synvisc-one, for…). 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 M19.111 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J7328 | Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg | Carrier judgment | — | 1 |
| J7318 | Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg | Carrier judgment | — | 1 |
| J7325 | Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg | Carrier judgment | — | 1 |
| J7320 | Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg | Carrier judgment | — | 1 |
| J7329 | Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg | Carrier judgment | — | 1 |
| J7322 | Hyaluronan or derivative, hymovis or hymovis one, for intra-articular injection, 1 mg | Carrier judgment | — | 1 |
| J7332 | Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg | Carrier judgment | — | 1 |
| J7331 | Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg | Carrier judgment | — | 1 |
| J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose | Carrier judgment | — | 1 |
| J7321 | Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose | Carrier judgment | — | 1 |
| J7324 | Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose | Carrier judgment | — | 1 |
| J7326 | Hyaluronan or derivative, gel-one, for intra-articular injection, per dose | Carrier judgment | — | 1 |
| J7327 | Hyaluronan or derivative, monovisc, for intra-articular injection, per dose | 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 | — | 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 |
| 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 |
Medicare policy articles listing M19.111
- A52420: Billing and Coding: Hyaluronans Intra-articular Injections of (Wellpoint Federal (MAC - Part A, MAC - Part B); 13 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
- 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 M19 diagnoses (Other and unspecified osteoarthritis)
- M19.112 — Post-traumatic osteoarthritis, left shoulder
- M19.121 — Post-traumatic osteoarthritis, right elbow
- M19.122 — Post-traumatic osteoarthritis, left elbow
- M19.131 — Post-traumatic osteoarthritis, right wrist
- M19.132 — Post-traumatic osteoarthritis, left wrist
- M19.141 — Post-traumatic osteoarthritis, right hand
- M19.142 — Post-traumatic osteoarthritis, left hand
- M19.171 — Post-traumatic osteoarthritis, right ankle and foot
- M19.172 — Post-traumatic osteoarthritis, left ankle and foot
- M19.19 — Post-traumatic osteoarthritis, other specified site
- M19.011 — Primary osteoarthritis, right shoulder
- M19.012 — Primary osteoarthritis, left shoulder
- M19.021 — Primary osteoarthritis, right elbow
- M19.022 — Primary osteoarthritis, left elbow
- M19.031 — Primary osteoarthritis, right wrist
- M19.032 — Primary osteoarthritis, left wrist
- M19.041 — Primary osteoarthritis, right hand
- M19.042 — Primary osteoarthritis, left hand
- M19.071 — Primary osteoarthritis, right ankle and foot
- M19.072 — Primary osteoarthritis, left ankle and foot
- M19.09 — Primary osteoarthritis, other specified site
- M19.211 — Secondary osteoarthritis, right shoulder
- M19.212 — Secondary osteoarthritis, left shoulder
- M19.221 — Secondary osteoarthritis, right elbow
- M19.222 — Secondary osteoarthritis, left elbow
- M19.231 — Secondary osteoarthritis, right wrist
- M19.232 — Secondary osteoarthritis, left wrist
- M19.241 — Secondary osteoarthritis, right hand
- M19.242 — Secondary osteoarthritis, left hand
- M19.271 — Secondary osteoarthritis, right ankle and foot
Frequently asked questions
Does Medicare cover M19.111 (Post-traumatic osteoarthritis, right shoulder)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list M19.111 as a covered diagnosis for 24 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 M19.111?
The Level II codes from the policies most specific to this diagnosis are J7328 (Hyaluronan or derivative, gelsyn-3, for intra-articular…, 1 article); J7318 (Hyaluronan or derivative, durolane, for intra-articular…, 1 article); J7325 (Hyaluronan or derivative, synvisc or synvisc-one, for…, 1 article); J7320 (Hyaluronan or derivitive, genvisc 850, for intra-articular…, 1 article); J7329 (Hyaluronan or derivative, trivisc, for intra-articular…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list M19.111?
A52420 (Billing and Coding: Hyaluronans Intra-articular Injections of); A53057 (Billing and Coding: Home Health Occupational Therapy); A53064 (Billing and Coding: Outpatient Occupational Therapy), and 1 more article.
What is ICD-10-CM code M19.111?
M19.111 is the ICD-10-CM code for post-traumatic osteoarthritis, right shoulder, in category M19 (Other and unspecified osteoarthritis), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under J7328
- Watch J7328 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7328
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