Is M75.1 a billable ICD-10-CM code?

No. M75.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does M75.1 sit in the tabular list?

Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Other soft tissue disorders (M70-M79).

What cannot be coded together with M75.1?

M75.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter.

M75.1

M75.1 — Rotator cuff tear or rupture, not specified as traumatic

Non-billable headerICD-10-CM

M75.1 is a non-billable header ICD-10-CM code for rotator cuff tear or rupture, not specified as traumatic. 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.

tear of rotator cuff, traumatic (S46.01-)

Inclusion terms

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

Rotator cuff syndrome
Supraspinatus tear or rupture, not specified as traumatic
Supraspinatus syndrome

Excludes2 inherited from the categories above M75.1

Also inherited, and the opposite of Excludes1: these conditions are not part of M75.1, but a patient can have both, so you may code both.

Written on M75 — Shoulder lesions

shoulder-hand syndrome (M89.0-)

Other codes that can never be billed with M75.1

These codes carry an Excludes1 note pointing at M75.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M75.1 alone.

S43.42Sprain of rotator cuff capsule

Risk adjustment

M75.1 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

M75.1 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 M75.1

3 child codes. Green means billable.

Related codes at this level

Codes that share M75. If M75.1 is not quite right, the correct code is usually one of these.

Questions about M75.1

Is M75.1 a billable ICD-10-CM code?: No. M75.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does M75.1 sit in the tabular list?: Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Other soft tissue disorders (M70-M79).
What cannot be coded together with M75.1?: M75.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter.