M43.28: Fusion of spine, sacral and sacrococcygeal region
M43.28, fusion of spine, sacral and sacrococcygeal region, is listed as a covered diagnosis in 10 Medicare billing and coding articles that apply to 21 HCPCS Level II codes, including G0260 (Injection procedure for sacroiliac joint; provision of…), G0283 (Electrical stimulation (unattended), to one or more areas…), E0783 (Infusion pump system, implantable, programmable (includes…). 4 of these codes have a 2026 DMEPOS fee schedule amount; E0783 pays $9,917.33 to $11,667.45 (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 M43.28 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G0260 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography | Special coverage instructions apply | — | 5 |
| 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 |
| E0783 | Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.) | Special coverage instructions apply | $9,917.33–$11,667.45 (NU) | 1 |
| E0786 | Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) | Special coverage instructions apply | $10,969.75–$11,380.88 (NU) | 1 |
| E0782 | Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.) | Special coverage instructions apply | $5,200.92–$6,118.73 (NU) | 1 |
| E0785 | Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement | Special coverage instructions apply | $572.38–$673.39 (KF) | 1 |
| J7999 | Compounded drug, not otherwise classified | Special coverage instructions apply | — | 1 |
| J2278 | Injection, ziconotide, 1 microgram | Special coverage instructions apply | — | 1 |
| J2274 | Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg | Special coverage instructions apply | — | 1 |
| A4220 | Refill kit for implantable infusion pump | Special coverage instructions apply | — | 1 |
| J9200 | Injection, floxuridine, 500 mg | Special coverage instructions apply | — | 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 |
| G2010 | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment | Carrier judgment | — | 1 |
| G2250 | Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment | 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 |
| G2251 | Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion | Carrier judgment | — | 1 |
| G0151 | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes | 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 |
| G0282 | Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281 | Non-covered by Medicare | Not covered | 1 |
| G0255 | Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve | Non-covered by Medicare | Not covered | 1 |
Medicare policy articles listing M43.28
- A59154: Billing and Coding: Sacroiliac Joint Injections and Procedures (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L39383, L39402, L39455, L39462
- A59192: Billing and Coding: Sacroiliac Joint Injections and Procedures (Palmetto GBA (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L39383, L39402, L39455, L39462
- A59233: Billing and Coding: Sacroiliac Joint Injections and Procedures (Wellpoint Federal (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L39383, L39402, L39455, L39462
- A59244: Billing and Coding: Sacroiliac Joint Injections and Procedures (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L39383, L39402, L39455, L39462
- A59257: Billing and Coding: Sacroiliac Joint Injections and Procedures (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L39383, L39402, L39455, L39462
- A56034: Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L35456
- 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
- A56695: Billing and Coding: Implantable Infusion Pump (Palmetto GBA (MAC - Part B); 9 Level II codes). LCD with the same title: L33461
- 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
- A57311: Billing and Coding: Physical Therapy - Home Health (CGS Administrators, LLC (HHH MAC); 7 Level II codes). LCD with the same title: L33942
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)
- M43.21 — 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
- M43.01 — 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
- M43.11 — 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
- M43.16 — Spondylolisthesis, lumbar region
- M43.17 — Spondylolisthesis, lumbosacral region
- M43.18 — Spondylolisthesis, sacral and sacrococcygeal region
- M43.19 — Spondylolisthesis, multiple sites in spine
- 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 M43.28 (Fusion of spine, sacral and sacrococcygeal region)?
Medicare covers items and services, not diagnoses. 10 Medicare billing and coding articles list M43.28 as a covered diagnosis for 21 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 M43.28?
The Level II codes from the policies most specific to this diagnosis are G0260 (Injection procedure for sacroiliac joint; provision of…, 5 articles); G0283 (Electrical stimulation (unattended), to one or more areas…, 2 articles); E0783 (Infusion pump system, implantable, programmable (includes…, 1 article); E0786 (Implantable programmable infusion pump, replacement…, 1 article); E0782 (Infusion pump, implantable, non-programmable (includes all…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with M43.28?
Under the 2026 DMEPOS fee schedule (non-rural state fees): E0783 $9,917.33 to $11,667.45 (NU); E0786 $10,969.75 to $11,380.88 (NU); E0782 $5,200.92 to $6,118.73 (NU); E0785 $572.38 to $673.39 (KF). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list M43.28?
A59154 (Billing and Coding: Sacroiliac Joint Injections and Procedures); A59192 (Billing and Coding: Sacroiliac Joint Injections and Procedures); A59233 (Billing and Coding: Sacroiliac Joint Injections and Procedures), and 7 more articles.
What is ICD-10-CM code M43.28?
M43.28 is the ICD-10-CM code for fusion of spine, sacral and sacrococcygeal 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 G0260
- Watch G0260 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0260
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