M43.25 — Fusion of spine, thoracolumbar region
M43.25 is a billable, specific ICD-10-CM code for fusion of spine, thoracolumbar region. It is valid for submission on a claim.
Risk adjustment
M43.25 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
M43.25 is named in 13 Medicare coverage policies — 7 listing it as supporting medical necessity, and 6 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
- 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
- A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
How M43.25 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 M43.25.
- Fusion, fused›spine NEC›thoracolumbar region
Related codes at this level
Codes that share M43.2. If M43.25 is not quite right, the correct code is usually one of these.
- M43.20Fusion of spine, site unspecified
- M43.21Fusion of spine, occipito-atlanto-axial region
- M43.22Fusion of spine, cervical region
- M43.23Fusion of spine, cervicothoracic region
- M43.24Fusion of spine, thoracic region
- M43.26Fusion of spine, lumbar region
- M43.27Fusion of spine, lumbosacral region
- M43.28Fusion of spine, sacral and sacrococcygeal region
Questions about M43.25
- Is M43.25 a billable ICD-10-CM code?
- Yes. M43.25 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M43.25 sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Deforming dorsopathies (M40-M43).