M35.03: Sjogren syndrome with myopathy
M35.03, sjogren syndrome with myopathy, is listed as a covered diagnosis in 10 Medicare billing and coding articles that apply to 13 HCPCS Level II codes, including A7020 (Interface for cough stimulating device, includes all…), J9312 (Injection, rituximab, 10 mg), Q5123 (Injection, rituximab-arrx, biosimilar, (riabni), 10 mg). 4 of these codes have a 2026 DMEPOS fee schedule amount; A7020 pays $19.87 to $23.81 (NU) depending on the state. The articles come from 5 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 M35.03 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| A7020 | Interface for cough stimulating device, includes all components, replacement only | Carrier judgment | $19.87–$23.81 (NU) | 1 |
| J9312 | Injection, rituximab, 10 mg | Special coverage instructions apply | — | 3 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | Carrier judgment | — | 3 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | Carrier judgment | — | 3 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | Special coverage instructions apply | — | 3 |
| E0483 | High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each | Carrier judgment | $1,515.12–$1,818.13 (RR) | 1 |
| A7025 | High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each | Carrier judgment | $61.99–$74.42 (RR) | 1 |
| A7026 | High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each | Carrier judgment | $40.96–$49.15 (NU) | 1 |
| 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 |
| G0255 | Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve | Non-covered by Medicare | Not covered | 5 |
Medicare policy articles listing M35.03
- A52510: Mechanical In-exsufflation Devices - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 1 Level II codes). LCD with the same title: L33795
- A52494: High Frequency Chest Wall Oscillation Devices - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 3 Level II codes). LCD with the same title: L33785
- 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
- A57307: Billing and Coding: Nerve Conduction Studies and Electromyography (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A57478: Billing and Coding: Nerve Conduction Studies and Electromyography (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A54969: Billing and Coding: Nerve Conduction Studies and Electromyography (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A57668: Billing and Coding: Nerve Conduction Studies and Electromyography (Wellpoint Federal (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A56619: Billing and Coding: Nerve Conduction Studies and Electromyography (Palmetto GBA (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
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 M35 diagnoses (Other systemic involvement of connective tissue)
- M35.02 — Sjogren syndrome with lung involvement
- M35.04 — Sjogren syndrome with tubulo-interstitial nephropathy
- M35.05 — Sjogren syndrome with inflammatory arthritis
- M35.06 — Sjogren syndrome with peripheral nervous system involvement
- M35.07 — Sjogren syndrome with central nervous system involvement
- M35.08 — Sjogren syndrome with gastrointestinal involvement
- M35.09 — Sjogren syndrome with other organ involvement
- M35.0A — Sjogren syndrome with glomerular disease
- M35.0B — Sjogren syndrome with vasculitis
- M35.2 — Behcet's disease
- M35.3 — Polymyalgia rheumatica
- M35.4 — Diffuse (eosinophilic) fasciitis
- M35.7 — Hypermobility syndrome
- M35.81 — Multisystem inflammatory syndrome
- M35.89 — Other specified systemic involvement of connective tissue
Frequently asked questions
Does Medicare cover M35.03 (Sjogren syndrome with myopathy)?
Medicare covers items and services, not diagnoses. 10 Medicare billing and coding articles list M35.03 as a covered diagnosis for 13 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 M35.03?
The Level II codes from the policies most specific to this diagnosis are A7020 (Interface for cough stimulating device, includes all…, 1 article); J9312 (Injection, rituximab, 10 mg, 3 articles); Q5123 (Injection, rituximab-arrx, biosimilar, (riabni), 10 mg, 3 articles); Q5119 (Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg, 3 articles); Q5115 (Injection, rituximab-abbs, biosimilar, (truxima), 10 mg, 3 articles). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with M35.03?
Under the 2026 DMEPOS fee schedule (non-rural state fees): A7020 $19.87 to $23.81 (NU); E0483 $1,515.12 to $1,818.13 (RR); A7025 $61.99 to $74.42 (RR); A7026 $40.96 to $49.15 (NU). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list M35.03?
A52510 (Mechanical In-exsufflation Devices - Policy Article); A52494 (High Frequency Chest Wall Oscillation Devices - Policy Article); A55639 (Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions), and 7 more articles.
What is ICD-10-CM code M35.03?
M35.03 is the ICD-10-CM code for sjogren syndrome with myopathy, in category M35 (Other systemic involvement of connective tissue), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under A7020
- Watch A7020 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A7020
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