M48.9: Spondylopathy, unspecified
M48.9, spondylopathy, unspecified, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 8 HCPCS Level II codes, including J1745 (Injection, infliximab, excludes biosimilar, 10 mg), Q5104 (Injection, infliximab-abda, biosimilar, (renflexis), 10 mg), Q5103 (Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg). 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 M48.9 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | Special coverage instructions apply | — | 1 |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | Special coverage instructions apply | — | 1 |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | Special coverage instructions apply | — | 1 |
| Q5121 | Injection, infliximab-axxq, biosimilar, (avsola), 10 mg | 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 | — | 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 | 1 |
Medicare policy articles listing M48.9
- A52423: Billing and Coding: Infliximab and biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B); 4 Level II codes)
- 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
- 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)
- M48.01 — Spinal stenosis, occipito-atlanto-axial region
- 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
Frequently asked questions
Does Medicare cover M48.9 (Spondylopathy, unspecified)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list M48.9 as a covered diagnosis for 8 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 M48.9?
The Level II codes from the policies most specific to this diagnosis are J1745 (Injection, infliximab, excludes biosimilar, 10 mg, 1 article); Q5104 (Injection, infliximab-abda, biosimilar, (renflexis), 10 mg, 1 article); Q5103 (Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg, 1 article); Q5121 (Injection, infliximab-axxq, biosimilar, (avsola), 10 mg, 1 article); G0283 (Electrical stimulation (unattended), to one or more areas…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list M48.9?
A52423 (Billing and Coding: Infliximab and biosimilars); A57668 (Billing and Coding: Nerve Conduction Studies and Electromyography); A53064 (Billing and Coding: Outpatient Occupational Therapy).
What is ICD-10-CM code M48.9?
M48.9 is the ICD-10-CM code for spondylopathy, unspecified, 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 J1745
- Watch J1745 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1745
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