M31.11: Hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA]
M31.11, hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA], is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 8 HCPCS Level II codes, including J9312 (Injection, rituximab, 10 mg), Q5119 (Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg), Q5115 (Injection, rituximab-abbs, biosimilar, (truxima), 10 mg). 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 M31.11 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 | — | 4 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | Carrier judgment | — | 4 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | Special coverage instructions apply | — | 4 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | Carrier judgment | — | 3 |
| 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 |
| J9311 | Injection, rituximab 10 mg and hyaluronidase | Special coverage instructions apply | — | 1 |
| J3590 | Unclassified biologics | Carrier judgment | — | 1 |
Medicare policy articles listing M31.11
- A58582: Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L38920, L39297
- A55639: Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 6 Level II codes)
- 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
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 M31 diagnoses (Other necrotizing vasculopathies)
- M31.19 — Other thrombotic microangiopathy
- M31.30 — Wegener's granulomatosis without renal involvement
- M31.31 — Wegener's granulomatosis with renal involvement
- M31.4 — Aortic arch syndrome [Takayasu]
- M31.5 — Giant cell arteritis with polymyalgia rheumatica
- M31.6 — Other giant cell arteritis
- M31.7 — Microscopic polyangiitis
Frequently asked questions
Does Medicare cover M31.11 (Hematopoietic stem cell transplantation-associated…)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list M31.11 as a covered diagnosis for 8 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 M31.11?
The Level II codes from the policies most specific to this diagnosis are J9312 (Injection, rituximab, 10 mg, 4 articles); Q5119 (Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg, 4 articles); Q5115 (Injection, rituximab-abbs, biosimilar, (truxima), 10 mg, 4 articles); Q5123 (Injection, rituximab-arrx, biosimilar, (riabni), 10 mg, 3 articles); J9260 (Injection, methotrexate sodium, 50 mg, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list M31.11?
A58582 (Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars); A55639 (Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions); A56380 (Billing and Coding: Rituximab), and 1 more article.
What is ICD-10-CM code M31.11?
M31.11 is the ICD-10-CM code for hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA], in category M31 (Other necrotizing vasculopathies), 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