M35.07: Sjogren syndrome with central nervous system involvement
M35.07, sjogren syndrome with central nervous system involvement, is listed as a covered diagnosis in 6 Medicare billing and coding articles that apply to 16 HCPCS Level II codes, including J9312 (Injection, rituximab, 10 mg), Q5123 (Injection, rituximab-arrx, biosimilar, (riabni), 10 mg), Q5119 (Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg). 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 M35.07 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 | — | 2 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | Carrier judgment | — | 2 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | Carrier judgment | — | 2 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | Special coverage instructions apply | — | 2 |
| 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 |
| 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 | — | 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 |
| 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 | — | 1 |
| 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 | — | 1 |
| G0255 | Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve | Non-covered by Medicare | Not covered | 2 |
Medicare policy articles listing M35.07
- 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
- 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
- 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
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
- M35.03 — Sjogren syndrome with myopathy
- M35.04 — Sjogren syndrome with tubulo-interstitial nephropathy
- M35.05 — Sjogren syndrome with inflammatory arthritis
- M35.06 — Sjogren syndrome with peripheral nervous system involvement
- M35.08 — 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 M35.07 (Sjogren syndrome with central nervous system involvement)?
Medicare covers items and services, not diagnoses. 6 Medicare billing and coding articles list M35.07 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 M35.07?
The Level II codes from the policies most specific to this diagnosis are J9312 (Injection, rituximab, 10 mg, 2 articles); Q5123 (Injection, rituximab-arrx, biosimilar, (riabni), 10 mg, 2 articles); Q5119 (Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg, 2 articles); Q5115 (Injection, rituximab-abbs, biosimilar, (truxima), 10 mg, 2 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 M35.07?
A55639 (Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions); A56380 (Billing and Coding: Rituximab); A57307 (Billing and Coding: Nerve Conduction Studies and Electromyography), and 3 more articles.
What is ICD-10-CM code M35.07?
M35.07 is the ICD-10-CM code for sjogren syndrome with central nervous system involvement, 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 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