M05.511 — Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder

Risk adjustment

M05.511 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

M05.511 is named in 43 Medicare coverage policies — 34 listing it as supporting medical necessity, and 9 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

• A56731Billing and Coding: Nerve Blocks and Electrostimulation for Peripheral Neuropathynot covered
• A57589Billing and Coding: Nerve Blocks for Peripheral Neuropathynot covered
• A57663Billing and Coding: Nerve Blocks for Peripheral Neuropathynot covered
• A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered