M25.559 — Pain in unspecified hip

Risk adjustment

M25.559 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

M25.559 is named in 19 Medicare coverage policies — 7 listing it as supporting medical necessity, and 12 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

• A57497Billing and Coding: Chest X-Ray Policynot covered
• A57701Billing and Coding: Trigger Point Injections (TPI)not covered
• 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