M84.550A: Pathological fracture in neoplastic disease, pelvis, initial encounter for fracture

M84.550A, pathological fracture in neoplastic disease, pelvis, 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 J0897 (Injection, denosumab, 1 mg), Q5136 (Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg), Q5157 (Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar…). 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 M84.550A as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
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
A9585Injection, gadobutrol, 0.1 mlCarrier judgment—1
Q9953Injection, iron-based magnetic resonance contrast agent, per mlSpecial coverage instructions apply—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
S2900Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)Not payable by MedicareNot covered1

Medicare policy articles listing M84.550A

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 M84 diagnoses (Disorder of continuity of bone)

Frequently asked questions

Does Medicare cover M84.550A (Pathological fracture in neoplastic disease, pelvis…)?

Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list M84.550A 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 M84.550A?

The Level II codes from the policies most specific to this diagnosis are J0897 (Injection, denosumab, 1 mg, 1 article); Q5136 (Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg, 1 article); Q5157 (Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar…, 1 article); Q5158 (Injection, denosumab-bnht (bomyntra/conexxence)…, 1 article); Q5159 (Injection, denosumab-dssb (ospomyv/xbryk), biosimilar, 1 mg, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list M84.550A?

A52399 (Billing and Coding: Denosumab (Prolia®, Xgeva®, Jubbonti®) and biosimilars); A60250 (Billing and Coding: Total Joint Arthroplasty); A57206 (Billing and Coding: Lumbar MRI), and 1 more article.

What is ICD-10-CM code M84.550A?

M84.550A is the ICD-10-CM code for pathological fracture in neoplastic disease, pelvis, initial encounter for fracture, in category M84 (Disorder of continuity of bone), 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