MCMedicalCodingSoftware
Free trial
M43.26

M43.26: Fusion of spine, lumbar region

Billable / specific codeICD-10-CM

M43.26 is a billable, specific ICD-10-CM code for fusion of spine, lumbar region. It is valid for submission on a claim.

Check M43.26 with the rest of the claim: free scrubber

Excludes1 inherited from the categories above M43.26

A category’s note binds every code beneath it.

Written on M43.2: Fusion of spine

  • ankylosing spondylitis (M45.0-)
  • congenital fusion of spine (Q76.4)

Written on M43: Other deforming dorsopathies

  • congenital spondylolysis and spondylolisthesis (Q76.2)
  • hemivertebra (Q76.3-Q76.4)
  • Klippel-Feil syndrome (Q76.1)
  • lumbarization and sacralization (Q76.4)
  • platyspondylisis (Q76.4)
  • spina bifida occulta (Q76.0)
  • spinal curvature in osteoporosis (M80.-)
  • spinal curvature in Paget's disease of bone [osteitis deformans] (M88.-)

Excludes2 inherited from the categories above M43.26

Not part of this code, but both may be coded when both are present.

Written on M43.2: Fusion of spine

  • arthrodesis status (Z98.1)
  • pseudoarthrosis after fusion or arthrodesis (M96.0)

Risk adjustment

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

Medicare coverage

M43.26 is named in 14 Medicare coverage policies: 7 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

  • Fusion, fused›spine NEC›lumbar

Code history

Unchanged in every release from FY2024 to FY2027.

Other codes under M43.2

ICD-10-CMFY2027· effective October 1, 2026

Loaded directly from the CMS/NCHS ICD-10-CM public-domain release: see data sources and our editorial policy. If this page disagrees with the CMS tabular list, this page is wrong. Reference information for professional coders; not medical or billing advice.