Is M26.04 a billable ICD-10-CM code?

Yes. M26.04 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does M26.04 sit in the tabular list?

Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Dentofacial anomalies [including malocclusion] and other disorders of jaw (M26-M27).

What cannot be coded together with M26.04?

M26.04 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 M26.04 (M26.0) and apply to it just the same.

M26.04

M26.04 — Mandibular hypoplasia

Billable / specific codeICD-10-CM

M26.04 is a billable, specific ICD-10-CM code for mandibular hypoplasia. It is valid for submission on a claim.

Excludes1 inherited from the categories above M26.04

These are not written on M26.04, but they bind it: a note on a category applies to every code beneath it. Billing M26.04 with anything listed here is a denial.

Written on M26.0 — Major anomalies of jaw size

acromegaly (E22.0)
Robin's syndrome (Q87.0)

Other codes that can never be billed with M26.04

These codes carry an Excludes1 note pointing at M26.04. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M26.04 alone.

Q38Other congenital malformations of tongue, mouth and pharynx
Q75Other congenital malformations of skull and face bones
Q67.4Other congenital deformities of skull, face and jaw
Q18Other congenital malformations of face and neck

Risk adjustment

M26.04 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

M26.04 is named in 8 Medicare coverage policies — 1 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

How M26.04 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 M26.04.

Hypoplasia, hypoplastic›mandible, mandibular
Hypoplasia, hypoplastic›jaw›lower
Anomaly, anomalous›dentofacial›jaw size›mandibular›hypoplasia

Code history

M26.04 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 M26.0. If M26.04 is not quite right, the correct code is usually one of these.

Questions about M26.04

Is M26.04 a billable ICD-10-CM code?: Yes. M26.04 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does M26.04 sit in the tabular list?: Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Dentofacial anomalies [including malocclusion] and other disorders of jaw (M26-M27).
What cannot be coded together with M26.04?: M26.04 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 M26.04 (M26.0) and apply to it just the same.