M48.01: Spinal stenosis, occipito-atlanto-axial region
M48.01, spinal stenosis, occipito-atlanto-axial region, is listed as a covered diagnosis in 10 Medicare billing and coding articles that apply to 19 HCPCS Level II codes, including G0283 (Electrical stimulation (unattended), to one or more areas…), G0453 (Continuous intraoperative neurophysiology monitoring, from…), 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 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 M48.01 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| 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 | — | 3 |
| 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 |
| 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 |
| 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 | 5 |
| G0282 | Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281 | Non-covered by Medicare | Not covered | 1 |
Medicare policy articles listing M48.01
- 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
- 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
- A56695: Billing and Coding: Implantable Infusion Pump (Palmetto GBA (MAC - Part B); 9 Level II codes). LCD with the same title: L33461
- 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 M48 diagnoses (Other spondylopathies)
- M48.02 — Spinal stenosis, cervical region
- M48.03 — Spinal stenosis, cervicothoracic region
- M48.04 — Spinal stenosis, thoracic region
- M48.05 — Spinal stenosis, thoracolumbar region
- M48.061 — Spinal stenosis, lumbar region without neurogenic claudication
- M48.062 — Spinal stenosis, lumbar region with neurogenic claudication
- M48.07 — Spinal stenosis, lumbosacral region
- M48.08 — Spinal stenosis, sacral and sacrococcygeal region
- M48.11 — Ankylosing hyperostosis [Forestier], occipito-atlanto-axial region
- M48.12 — Ankylosing hyperostosis [Forestier], cervical region
- M48.13 — Ankylosing hyperostosis [Forestier], cervicothoracic region
- M48.14 — Ankylosing hyperostosis [Forestier], thoracic region
- M48.15 — Ankylosing hyperostosis [Forestier], thoracolumbar region
- M48.16 — Ankylosing hyperostosis [Forestier], lumbar region
- M48.17 — Ankylosing hyperostosis [Forestier], lumbosacral region
- M48.18 — Ankylosing hyperostosis [Forestier], sacral and sacrococcygeal region
- M48.19 — Ankylosing hyperostosis [Forestier], multiple sites in spine
- M48.21 — Kissing spine, occipito-atlanto-axial region
- M48.22 — Kissing spine, cervical region
- M48.23 — Kissing spine, cervicothoracic region
- M48.24 — Kissing spine, thoracic region
- M48.25 — Kissing spine, thoracolumbar region
- M48.26 — Kissing spine, lumbar region
- M48.27 — Kissing spine, lumbosacral region
- M48.31 — Traumatic spondylopathy, occipito-atlanto-axial region
- M48.32 — Traumatic spondylopathy, cervical region
- M48.33 — Traumatic spondylopathy, cervicothoracic region
- M48.34 — Traumatic spondylopathy, thoracic region
- M48.35 — Traumatic spondylopathy, thoracolumbar region
- M48.36 — Traumatic spondylopathy, lumbar region
Frequently asked questions
Does Medicare cover M48.01 (Spinal stenosis, occipito-atlanto-axial region)?
Medicare covers items and services, not diagnoses. 10 Medicare billing and coding articles list M48.01 as a covered diagnosis for 19 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 M48.01?
The Level II codes from the policies most specific to this diagnosis are G0283 (Electrical stimulation (unattended), to one or more areas…, 3 articles); G0453 (Continuous intraoperative neurophysiology monitoring, from…, 1 article); 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 M48.01?
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 M48.01?
A56034 (Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy); A56722 (Billing and Coding: Intraoperative Neurophysiological Testing); A57307 (Billing and Coding: Nerve Conduction Studies and Electromyography), and 7 more articles.
What is ICD-10-CM code M48.01?
M48.01 is the ICD-10-CM code for spinal stenosis, occipito-atlanto-axial region, in category M48 (Other spondylopathies), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under G0283
- Watch G0283 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0283
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