M43.16: Spondylolisthesis, lumbar region
M43.16, spondylolisthesis, lumbar region, is listed as a covered diagnosis in 7 Medicare billing and coding articles that apply to 4 HCPCS Level II codes, including G0453 (Continuous intraoperative neurophysiology monitoring, from…), A9585 (Injection, gadobutrol, 0.1 ml), Q9953 (Injection, iron-based magnetic resonance contrast agent…). The articles come from 6 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 M43.16 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G0453 | Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure) | Carrier judgment | — | 1 |
| A9585 | Injection, gadobutrol, 0.1 ml | Carrier judgment | — | 1 |
| Q9953 | Injection, iron-based magnetic resonance contrast agent, per ml | Special coverage instructions apply | — | 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 M43.16
- A56722: Billing and Coding: Intraoperative Neurophysiological Testing (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34623, L35003
- 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
- A57206: Billing and Coding: Lumbar MRI (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L34220
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 M43 diagnoses (Other deforming dorsopathies)
- M43.11 — Spondylolisthesis, occipito-atlanto-axial region
- M43.12 — Spondylolisthesis, cervical region
- M43.13 — Spondylolisthesis, cervicothoracic region
- M43.14 — Spondylolisthesis, thoracic region
- M43.15 — Spondylolisthesis, thoracolumbar region
- M43.17 — Spondylolisthesis, lumbosacral region
- M43.18 — Spondylolisthesis, sacral and sacrococcygeal region
- M43.19 — Spondylolisthesis, multiple sites in spine
- M43.01 — Spondylolysis, occipito-atlanto-axial region
- M43.02 — Spondylolysis, cervical region
- M43.03 — Spondylolysis, cervicothoracic region
- M43.04 — Spondylolysis, thoracic region
- M43.05 — Spondylolysis, thoracolumbar region
- M43.06 — Spondylolysis, lumbar region
- M43.07 — Spondylolysis, lumbosacral region
- M43.08 — Spondylolysis, sacral and sacrococcygeal region
- M43.09 — Spondylolysis, multiple sites in spine
- M43.21 — Fusion of spine, occipito-atlanto-axial region
- M43.22 — Fusion of spine, cervical region
- M43.23 — Fusion of spine, cervicothoracic region
- M43.24 — Fusion of spine, thoracic region
- M43.25 — Fusion of spine, thoracolumbar region
- M43.26 — Fusion of spine, lumbar region
- M43.27 — Fusion of spine, lumbosacral region
- M43.28 — Fusion of spine, sacral and sacrococcygeal region
- M43.6 — Torticollis
- M43.8X1 — Other specified deforming dorsopathies, occipito-atlanto-axial region
- M43.8X2 — Other specified deforming dorsopathies, cervical region
- M43.8X3 — Other specified deforming dorsopathies, cervicothoracic region
- M43.8X4 — Other specified deforming dorsopathies, thoracic region
Frequently asked questions
Does Medicare cover M43.16 (Spondylolisthesis, lumbar region)?
Medicare covers items and services, not diagnoses. 7 Medicare billing and coding articles list M43.16 as a covered diagnosis for 4 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 M43.16?
The Level II codes from the policies most specific to this diagnosis are G0453 (Continuous intraoperative neurophysiology monitoring, from…, 1 article); A9585 (Injection, gadobutrol, 0.1 ml, 1 article); Q9953 (Injection, iron-based magnetic resonance contrast agent…, 1 article); G0255 (Current perception threshold/sensory nerve conduction…, 5 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list M43.16?
A56722 (Billing and Coding: Intraoperative Neurophysiological Testing); A57307 (Billing and Coding: Nerve Conduction Studies and Electromyography); A57478 (Billing and Coding: Nerve Conduction Studies and Electromyography), and 4 more articles.
What is ICD-10-CM code M43.16?
M43.16 is the ICD-10-CM code for spondylolisthesis, lumbar region, in category M43 (Other deforming dorsopathies), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under G0453
- Watch G0453 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0453
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