M26.54

M26.54: Insufficient anterior guidance

Billable / specific codeICD-10-CM

M26.54 is a billable, specific ICD-10-CM code for insufficient anterior guidance. It is valid for submission on a claim.

Check M26.54 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Insufficient anterior occlusal guidance

Excludes1 inherited from the categories above M26.54

A category’s note binds every code beneath it.

Written on M26.5: Dentofacial functional abnormalities

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

Other codes that can never be billed with M26.54

Their own Excludes1 notes name this code, so the conflict is not listed above.

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

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

M26.54 is named in 8 Medicare coverage policies: 1 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which one applies depends on your Medicare contractor.

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