Is M26.5 a billable ICD-10-CM code?

No. M26.5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does M26.5 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 M26.5?

M26.5 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter.

M26.5

M26.5 — Dentofacial functional abnormalities

Non-billable headerICD-10-CM

M26.5 is a non-billable header ICD-10-CM code for dentofacial functional abnormalities. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

bruxism (F45.8)
teeth-grinding NOS (F45.8)

Other codes that can never be billed with M26.5

These codes carry an Excludes1 note pointing at M26.5. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M26.5 alone.

M26.55Centric occlusion maximum intercuspation discrepancy
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

M26.5 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.

Code history

M26.5 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead M26.5

9 child codes. Green means billable.

Related codes at this level

Codes that share M26. If M26.5 is not quite right, the correct code is usually one of these.

Questions about M26.5

Is M26.5 a billable ICD-10-CM code?: No. M26.5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does M26.5 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 M26.5?: M26.5 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter.