M80.012A: Age-related osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture

M80.012A, age-related osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 20 HCPCS Level II codes, including J1740 (Injection, ibandronate sodium, 1 mg), J3489 (Injection, zoledronic acid, 1 mg), J2430 (Injection, pamidronate disodium, per 30 mg). The articles come from 3 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 M80.012A as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
J1740Injection, ibandronate sodium, 1 mgCarrier judgment—2
J3489Injection, zoledronic acid, 1 mgCarrier judgment—1
J2430Injection, pamidronate disodium, per 30 mgSpecial coverage instructions apply—1
J0897Injection, denosumab, 1 mgCarrier judgment—1
Q5136Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mgCarrier judgment—1
Q5157Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mgCarrier judgment—1
Q5158Injection, denosumab-bnht (bomyntra/conexxence), biosimilar, 1 mgCarrier judgment—1
Q5159Injection, denosumab-dssb (ospomyv/xbryk), biosimilar, 1 mgCarrier judgment—1
Q5162Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mgCarrier judgment—1
Q5165Injection, denosumab-mobz (oziltus), biosimilar, 1 mgCarrier judgment—1
Q5166Injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mgCarrier judgment—1
Q5167Injection, denosumab-qbde (enoby/xtrenbo), biosimilar, 1 mgCarrier judgment—1
Q5171Injection, denosumab-mobz (boncresa), biosimilar, 1 mgCarrier judgment—1
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of careCarrier judgment—1
G2010Remote 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 appointmentCarrier judgment—1
G2250Remote 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 appointmentCarrier judgment—1
G0281Electrical 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 careCarrier judgment—1
G2251Brief 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 discussionCarrier judgment—1
G0151Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutesCarrier judgment—1
G0329Electromagnetic 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 careCarrier judgment—1

Medicare policy articles listing M80.012A

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 M80 diagnoses (Osteoporosis with current pathological fracture)

Frequently asked questions

Does Medicare cover M80.012A (Age-related osteoporosis with current pathological…)?

Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list M80.012A as a covered diagnosis for 20 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 M80.012A?

The Level II codes from the policies most specific to this diagnosis are J1740 (Injection, ibandronate sodium, 1 mg, 2 articles); J3489 (Injection, zoledronic acid, 1 mg, 1 article); J2430 (Injection, pamidronate disodium, per 30 mg, 1 article); J0897 (Injection, denosumab, 1 mg, 1 article); Q5136 (Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list M80.012A?

A56907 (Billing and Coding: Bisphosphonate Drug Therapy); A52421 (Billing and Coding: Ibandronate Sodium); A52399 (Billing and Coding: Denosumab (Prolia®, Xgeva®, Jubbonti®) and biosimilars), and 1 more article.

What is ICD-10-CM code M80.012A?

M80.012A is the ICD-10-CM code for age-related osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture, in category M80 (Osteoporosis with current pathological fracture), chapter 13: Diseases of the musculoskeletal system and connective tissue.

Next steps

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