M46.07: Spinal enthesopathy, lumbosacral region
M46.07, spinal enthesopathy, lumbosacral region, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 14 HCPCS Level II codes, including E0783 (Infusion pump system, implantable, programmable (includes…), E0786 (Implantable programmable infusion pump, replacement…), E0782 (Infusion pump, implantable, non-programmable (includes all…). 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 2 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 M46.07 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| 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 |
| 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 | — | 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 |
Medicare policy articles listing M46.07
- 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
- 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 M46 diagnoses (Other inflammatory spondylopathies)
- M46.05 — Spinal enthesopathy, thoracolumbar region
- M46.06 — Spinal enthesopathy, lumbar region
- M46.08 — Spinal enthesopathy, sacral and sacrococcygeal region
- M46.09 — Spinal enthesopathy, multiple sites in spine
- M46.1 — Sacroiliitis, not elsewhere classified
- M46.41 — Discitis, unspecified, occipito-atlanto-axial region
- M46.42 — Discitis, unspecified, cervical region
- M46.43 — Discitis, unspecified, cervicothoracic region
- M46.44 — Discitis, unspecified, thoracic region
- M46.45 — Discitis, unspecified, thoracolumbar region
- M46.46 — Discitis, unspecified, lumbar region
- M46.47 — Discitis, unspecified, lumbosacral region
- M46.48 — Discitis, unspecified, sacral and sacrococcygeal region
- M46.49 — Discitis, unspecified, multiple sites in spine
- M46.51 — Other infective spondylopathies, occipito-atlanto-axial region
- M46.52 — Other infective spondylopathies, cervical region
- M46.53 — Other infective spondylopathies, cervicothoracic region
- M46.54 — Other infective spondylopathies, thoracic region
- M46.55 — Other infective spondylopathies, thoracolumbar region
- M46.56 — Other infective spondylopathies, lumbar region
- M46.57 — Other infective spondylopathies, lumbosacral region
- M46.58 — Other infective spondylopathies, sacral and sacrococcygeal region
- M46.59 — Other infective spondylopathies, multiple sites in spine
- M46.81 — Other specified inflammatory spondylopathies, occipito-atlanto-axial…
- M46.82 — Other specified inflammatory spondylopathies, cervical region
- M46.83 — Other specified inflammatory spondylopathies, cervicothoracic region
- M46.84 — Other specified inflammatory spondylopathies, thoracic region
- M46.85 — Other specified inflammatory spondylopathies, thoracolumbar region
- M46.86 — Other specified inflammatory spondylopathies, lumbar region
- M46.87 — Other specified inflammatory spondylopathies, lumbosacral region
Frequently asked questions
Does Medicare cover M46.07 (Spinal enthesopathy, lumbosacral region)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list M46.07 as a covered diagnosis for 14 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 M46.07?
The Level II codes from the policies most specific to this diagnosis are 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); E0785 (Implantable intraspinal (epidural/intrathecal) catheter…, 1 article); J7999 (Compounded drug, not otherwise classified, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with M46.07?
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 M46.07?
A56695 (Billing and Coding: Implantable Infusion Pump); A57206 (Billing and Coding: Lumbar MRI); A53064 (Billing and Coding: Outpatient Occupational Therapy).
What is ICD-10-CM code M46.07?
M46.07 is the ICD-10-CM code for spinal enthesopathy, lumbosacral region, in category M46 (Other inflammatory spondylopathies), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under E0783
- Watch E0783 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for E0783
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