M35.3

M35.3: Polymyalgia rheumatica

Billable / specific codeICD-10-CM

M35.3 is a billable, specific ICD-10-CM code for polymyalgia rheumatica. It is valid for submission on a claim.

Check M35.3 with the rest of the claim: free scrubber

Excludes1: never code together

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

polymyalgia rheumatica with giant cell arteritis (M31.5)

Excludes1 inherited from the categories above M35.3

A category’s note binds every code beneath it.

Written on M35: Other systemic involvement of connective tissue

reactive perforating collagenosis (L87.1)

Risk adjustment

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

Medicare coverage

M35.3 is named in 17 Medicare coverage policies: 10 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

Alphabetic index entries that lead here

Forestier's disease(rhizomelic pseudopolyarthritis)
Polymyalgia
Pseudopolyarthritis, rhizomelic
Disease, diseased›Forestier's(rhizomelic pseudopolyarthritis)
Polymyalgia›rheumatica

Code history

Unchanged in every release from FY2024 to FY2027.