M04.1 — Periodic fever syndromes
M04.1 is a billable, specific ICD-10-CM code for periodic fever syndromes. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Familial Mediterranean fever
- Hyperimmunoglobin D syndrome
- Mevalonate kinase deficiency
- Tumor necrosis factor receptor associated periodic syndrome [TRAPS]
Risk adjustment
M04.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 94 Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders0.268 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
M04.1 is named in 6 Medicare coverage policies — 0 listing it as supporting medical necessity, and 6 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
- 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
- A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
How M04.1 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to M04.1.
- TRAPS(tumor necrosis factor receptor associated periodic syndrome)
- Deficiency, deficient›mevalonate kinase
- Fever›periodic(Mediterranean)
- Syndrome›hyperimmunoglobulin D
- Syndrome›periodic fever
- Syndrome›tumor necrosis factor receptor associated periodic(TRAPS)
- Arthritis, arthritic›in›Mediterranean fever, familial
- Fever›Mediterranean›familial
- Mediterranean›fever›familial
Related codes at this level
Codes that share M04. If M04.1 is not quite right, the correct code is usually one of these.
Questions about M04.1
- Is M04.1 a billable ICD-10-CM code?
- Yes. M04.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M04.1 sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Autoinflammatory syndromes (M04).