M79.7: Fibromyalgia
M79.7, fibromyalgia, is listed as a covered diagnosis in 14 Medicare billing and coding articles that apply to 13 HCPCS Level II codes, including G0480 (Drug test(s), definitive, utilizing (1) drug…), G0483 (Drug test(s), definitive, utilizing (1) drug…), G0482 (Drug test(s), definitive, utilizing (1) drug…). The articles come from 7 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 M79.7 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed | Carrier judgment | — | 7 |
| G0483 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed | Carrier judgment | — | 7 |
| G0482 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed | Carrier judgment | — | 7 |
| G0481 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed | Carrier judgment | — | 7 |
| G0659 | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes | Carrier judgment | — | 7 |
| 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 |
| 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 |
Medicare policy articles listing M79.7
- A57077: Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35006, L36393
- A55001: Billing and Coding: Urine Drug Testing (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L34645, L35724, L36029, L36668
- A56915: Billing and Coding: Urine Drug Testing (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L34645, L35724, L36029, L36668
- A59416: Billing and Coding: Urine Drug Testing (Wellpoint Federal (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L34645, L35724, L36029, L36668
- A54799: Billing and Coding: Urine Drug Testing (Palmetto GBA (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L34645, L35724, L36029, L36668
- A56818: Billing and Coding: Urine Drug Testing (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L34645, L35724, L36029, L36668
- 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
- A56645: Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35006, L36393
- 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
- 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 M79 diagnoses (Other and unspecified soft tissue disorders, not elsewhere classified)
- M79.10 — Myalgia, unspecified site
- M79.11 — Myalgia of mastication muscle
- M79.12 — Myalgia of auxiliary muscles, head and neck
- M79.18 — Myalgia, other site
- M79.2 — Neuralgia and neuritis, unspecified
- M79.601 — Pain in right arm
- M79.602 — Pain in left arm
- M79.604 — Pain in right leg
- M79.605 — Pain in left leg
- M79.621 — Pain in right upper arm
- M79.622 — Pain in left upper arm
- M79.631 — Pain in right forearm
- M79.632 — Pain in left forearm
- M79.641 — Pain in right hand
- M79.642 — Pain in left hand
- M79.644 — Pain in right finger(s)
- M79.645 — Pain in left finger(s)
- M79.651 — Pain in right thigh
- M79.652 — Pain in left thigh
- M79.661 — Pain in right lower leg
- M79.662 — Pain in left lower leg
- M79.671 — Pain in right foot
- M79.672 — Pain in left foot
- M79.674 — Pain in right toe(s)
- M79.675 — Pain in left toe(s)
- M79.81 — Nontraumatic hematoma of soft tissue
- M79.89 — Other specified soft tissue disorders
- M79.A11 — Nontraumatic compartment syndrome of right upper extremity
- M79.A12 — Nontraumatic compartment syndrome of left upper extremity
Frequently asked questions
Does Medicare cover M79.7 (Fibromyalgia)?
Medicare covers items and services, not diagnoses. 14 Medicare billing and coding articles list M79.7 as a covered diagnosis for 13 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 M79.7?
The Level II codes from the policies most specific to this diagnosis are G0480 (Drug test(s), definitive, utilizing (1) drug…, 7 articles); G0483 (Drug test(s), definitive, utilizing (1) drug…, 7 articles); G0482 (Drug test(s), definitive, utilizing (1) drug…, 7 articles); G0481 (Drug test(s), definitive, utilizing (1) drug…, 7 articles); G0659 (Drug test(s), definitive, utilizing drug identification…, 7 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list M79.7?
A57077 (Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing); A55001 (Billing and Coding: Urine Drug Testing); A56915 (Billing and Coding: Urine Drug Testing), and 11 more articles.
What is ICD-10-CM code M79.7?
M79.7 is the ICD-10-CM code for fibromyalgia, in category M79 (Other and unspecified soft tissue disorders, not elsewhere classified), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under G0480
- Watch G0480 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0480
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