M34.81: Systemic sclerosis with lung involvement
M34.81, systemic sclerosis with lung involvement, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 16 HCPCS Level II codes, including G0238 (Therapeutic procedures to improve respiratory function…), G0237 (Therapeutic procedures to increase strength or endurance…), G0239 (Therapeutic procedures to improve respiratory function or…). 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 M34.81 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G0238 | Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) | Carrier judgment | — | 2 |
| G0237 | Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring) | Carrier judgment | — | 2 |
| G0239 | Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring) | Carrier judgment | — | 2 |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | Special coverage instructions apply | — | 1 |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | Special coverage instructions apply | — | 1 |
| Q5106 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units | Special coverage instructions apply | — | 1 |
| J0882 | Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) | Special coverage instructions apply | — | 1 |
| J0888 | Injection, epoetin beta, 1 microgram, (for non esrd use) | Special coverage instructions apply | — | 1 |
| Q5105 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units | Special coverage instructions apply | — | 1 |
| J0887 | Injection, epoetin beta, 1 microgram, (for esrd on dialysis) | Special coverage instructions apply | — | 1 |
| J0890 | Injection, peginesatide, 0.1 mg (for esrd on dialysis) | Carrier judgment | — | 1 |
| Q4081 | Injection, epoetin alfa, 100 units (for esrd on dialysis) | Special coverage instructions apply | — | 1 |
| J9312 | Injection, rituximab, 10 mg | Special coverage instructions apply | — | 1 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | Carrier judgment | — | 1 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | Carrier judgment | — | 1 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | Special coverage instructions apply | — | 1 |
Medicare policy articles listing M34.81
- 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
- A56717: Billing and Coding: Respiratory Therapy (Respiratory Care) (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34430
- 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
- A57224: Billing and Coding: Respiratory Care (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L34149
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 M34 diagnoses (Systemic sclerosis [scleroderma])
- M34.82 — Systemic sclerosis with myopathy
- M34.83 — Systemic sclerosis with polyneuropathy
- M34.89 — Other systemic sclerosis
- M34.0 — Progressive systemic sclerosis
- M34.1 — CR(E)ST syndrome
- M34.2 — Systemic sclerosis induced by drug and chemical
Frequently asked questions
Does Medicare cover M34.81 (Systemic sclerosis with lung involvement)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list M34.81 as a covered diagnosis for 16 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 M34.81?
The Level II codes from the policies most specific to this diagnosis are G0238 (Therapeutic procedures to improve respiratory function…, 2 articles); G0237 (Therapeutic procedures to increase strength or endurance…, 2 articles); G0239 (Therapeutic procedures to improve respiratory function or…, 2 articles); J0881 (Injection, darbepoetin alfa, 1 microgram (non-esrd use), 1 article); J0885 (Injection, epoetin alfa, (for non-esrd use), 1000 units, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list M34.81?
A56795 (Billing and Coding: Erythropoiesis Stimulating Agents (ESAs)); A56717 (Billing and Coding: Respiratory Therapy (Respiratory Care)); A59101 (Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars), and 1 more article.
What is ICD-10-CM code M34.81?
M34.81 is the ICD-10-CM code for systemic sclerosis with lung involvement, in category M34 (Systemic sclerosis [scleroderma]), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under G0238
- Watch G0238 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0238
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