M05.461 — Rheumatoid myopathy with rheumatoid arthritis of right knee

Risk adjustment

M05.461 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 93 Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders0.617 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

M05.461 is named in 45 Medicare coverage policies — 39 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