Is M01.X12 a billable ICD-10-CM code?

Yes. M01.X12 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does M01.X12 sit in the tabular list?

Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Infectious arthropathies (M00-M02).

What cannot be coded together with M01.X12?

M01.X12 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M01.X12 (M01) and apply to it just the same.

M01.X12

M01.X12 — Direct infection of left shoulder in infectious and parasitic diseases classified elsewhere

Billable / specific codeICD-10-CMleft

M01.X12 is a billable, specific ICD-10-CM code for direct infection of left shoulder in infectious and parasitic diseases classified elsewhere. It is valid for submission on a claim.

Excludes1 inherited from the categories above M01.X12

These are not written on M01.X12, but they bind it: a note on a category applies to every code beneath it. Billing M01.X12 with anything listed here is a denial.

Written on M01 — Direct infections of joint in infectious and parasitic diseases classified elsewhere

arthropathy in Lyme disease (A69.23)
gonococcal arthritis (A54.42)
meningococcal arthritis (A39.83)
mumps arthritis (B26.85)
postinfective arthropathy (M02.-)
postmeningococcal arthritis (A39.84)
reactive arthritis (M02.3)
rubella arthritis (B06.82)
sarcoidosis arthritis (D86.86)
typhoid fever arthritis (A01.04)
tuberculosis arthritis (A18.01-A18.02)

Other codes that can never be billed with M01.X12

These codes carry an Excludes1 note pointing at M01.X12. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M01.X12 alone.

M02Postinfective and reactive arthropathies

Risk adjustment

M01.X12 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 92 Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis0.479 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

M01.X12 is named in 13 Medicare coverage policies — 6 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58883Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered

Code history

M01.X12 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share M01.X1. If M01.X12 is not quite right, the correct code is usually one of these.

Questions about M01.X12

Is M01.X12 a billable ICD-10-CM code?: Yes. M01.X12 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does M01.X12 sit in the tabular list?: Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Infectious arthropathies (M00-M02).
What cannot be coded together with M01.X12?: M01.X12 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M01.X12 (M01) and apply to it just the same.