M81.8: Other osteoporosis without current pathological fracture
M81.8, other osteoporosis without current pathological fracture, is listed as a covered diagnosis in 6 Medicare billing and coding articles that apply to 16 HCPCS Level II codes, including J1740 (Injection, ibandronate sodium, 1 mg), G0130 (Single energy x-ray absorptiometry (sexa) bone density…), J3489 (Injection, zoledronic acid, 1 mg). The articles come from 5 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 M81.8 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J1740 | Injection, ibandronate sodium, 1 mg | Carrier judgment | — | 2 |
| G0130 | Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) | Special coverage instructions apply | — | 2 |
| J3489 | Injection, zoledronic acid, 1 mg | Carrier judgment | — | 1 |
| J2430 | Injection, pamidronate disodium, per 30 mg | Special coverage instructions apply | — | 1 |
| J0897 | Injection, denosumab, 1 mg | Carrier judgment | — | 1 |
| Q5136 | Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg | Carrier judgment | — | 1 |
| Q5157 | Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mg | Carrier judgment | — | 1 |
| Q5158 | Injection, denosumab-bnht (bomyntra/conexxence), biosimilar, 1 mg | Carrier judgment | — | 1 |
| Q5159 | Injection, denosumab-dssb (ospomyv/xbryk), biosimilar, 1 mg | Carrier judgment | — | 1 |
| Q5162 | Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mg | Carrier judgment | — | 1 |
| Q5165 | Injection, denosumab-mobz (oziltus), biosimilar, 1 mg | Carrier judgment | — | 1 |
| Q5166 | Injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mg | Carrier judgment | — | 1 |
| Q5167 | Injection, denosumab-qbde (enoby/xtrenbo), biosimilar, 1 mg | Carrier judgment | — | 1 |
| Q5171 | Injection, denosumab-mobz (boncresa), biosimilar, 1 mg | Carrier judgment | — | 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 |
Medicare policy articles listing M81.8
- A56907: Billing and Coding: Bisphosphonate Drug Therapy (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L34648
- A52421: Billing and Coding: Ibandronate Sodium (Wellpoint Federal (MAC - Part A, MAC - Part B); 1 Level II codes)
- A59040: Billing and Coding: Bone Mass Measurement (Palmetto GBA (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L36460, L39268
- A57132: Billing and Coding: Bone Mass Measurement (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L36460, L39268
- A52399: Billing and Coding: Denosumab (Prolia®, Xgeva®, Jubbonti®) and biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B); 10 Level II codes)
- 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
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 M81 diagnoses (Osteoporosis without current pathological fracture)
- M81.0 — Age-related osteoporosis without current pathological fracture
- M81.6 — Localized osteoporosis [Lequesne]
Frequently asked questions
Does Medicare cover M81.8 (Other osteoporosis without current pathological fracture)?
Medicare covers items and services, not diagnoses. 6 Medicare billing and coding articles list M81.8 as a covered diagnosis for 16 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 M81.8?
The Level II codes from the policies most specific to this diagnosis are J1740 (Injection, ibandronate sodium, 1 mg, 2 articles); G0130 (Single energy x-ray absorptiometry (sexa) bone density…, 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). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list M81.8?
A56907 (Billing and Coding: Bisphosphonate Drug Therapy); A52421 (Billing and Coding: Ibandronate Sodium); A59040 (Billing and Coding: Bone Mass Measurement), and 3 more articles.
What is ICD-10-CM code M81.8?
M81.8 is the ICD-10-CM code for other osteoporosis without current pathological fracture, in category M81 (Osteoporosis without current pathological fracture), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under J1740
- Watch J1740 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1740
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