M84.68XA: Pathological fracture in other disease, other site, initial encounter for fracture

M84.68XA, pathological fracture in other disease, other site, initial encounter for fracture, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 4 HCPCS Level II codes, including G0130 (Single energy x-ray absorptiometry (sexa) bone density…), G0453 (Continuous intraoperative neurophysiology monitoring, from…), A9585 (Injection, gadobutrol, 0.1 ml). The articles come from 4 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 M84.68XA as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
G0130Single 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
G0453Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)Carrier judgment—1
A9585Injection, gadobutrol, 0.1 mlCarrier judgment—1
Q9953Injection, iron-based magnetic resonance contrast agent, per mlSpecial coverage instructions apply—1

Medicare policy articles listing M84.68XA

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 M84.68XA (Pathological fracture in other disease, other site…)?

Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list M84.68XA as a covered diagnosis for 4 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 M84.68XA?

The Level II codes from the policies most specific to this diagnosis are G0130 (Single energy x-ray absorptiometry (sexa) bone density…, 2 articles); G0453 (Continuous intraoperative neurophysiology monitoring, from…, 1 article); A9585 (Injection, gadobutrol, 0.1 ml, 1 article); Q9953 (Injection, iron-based magnetic resonance contrast agent…, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list M84.68XA?

A59040 (Billing and Coding: Bone Mass Measurement); A57132 (Billing and Coding: Bone Mass Measurement); A57604 (Billing and Coding: Intraoperative Neurophysiological Testing), and 1 more article.

What is ICD-10-CM code M84.68XA?

M84.68XA is the ICD-10-CM code for pathological fracture in other disease, other site, 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