2026 ICD-10-CM Diagnosis Code M05.019Felty's syndrome, unspecified shoulder

ICD-10-CM Codes›M00–M99›M05-M14›M05

ICD-10-CM M05.019
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

M05.019 is a billable ICD-10-CM diagnosis code for Felty's syndrome, unspecified shoulder. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 545 through 547. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Rheumatoid arthritis and related disease.

For Medicare Advantage risk adjustment, M05.019 maps to CMS-HCC Category 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders) under the V28 model, adding a risk factor of about 0.617 for a community, non-dual, aged beneficiary in payment year 2026.

Code Identity

ICD-10-CM Code
M05.019
Billable Status
Yes — Valid for Submission
Code Describes
Felty's syndrome, unspecified shoulder
Short Description
Felty's syndrome, unspecified shoulder
Same as the full description in the CMS dataset.
Parent Code
M05.01
Felty's syndrome, shoulder

Code Classification

ChapterM00–M99Diseases of the musculoskeletal system and connective tissue
SectionM05-M14Inflammatory polyarthropathies
CategoryM05Rheumatoid arthritis with rheumatoid factor
This CodeM05.019Felty's syndrome, unspecified shoulder

Medicare Risk Adjustment (HCC)Billing

M05.019 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.

CMS-HCC V28 Category (Payment Model)
HCC 93— Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders
Payment HCC · PY 2026 one of 508 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.617
community, non-dual, aged · ranges 0.288–0.617 across segments
Hierarchy
Supersedes HCC 94
less severe related categories are not paid alongside HCC 93
Prior Model (CMS-HCC V24)
HCC 40
V24 retired V28 pays 100% of MA risk scores since PY 2026
Other CMS Models
PACE (CMS-HCC V22): HCC 40 · ESRD (V21): HCC 40 · ESRD (V24): HCC 40
ESRD V21 weights: 0.072 dialysis, 0.274–0.398 functioning graft · ESRD V24 weights: 0.058 dialysis, 0.284–0.414 functioning graft
Part D (RxHCC)
RxHCC 83 — Rheumatoid Arthritis and Other Inflammatory Polyarthropathy
also risk-adjusts in the Part D prescription drug model (V08)

Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR MUS003
Rheumatoid arthritis and related disease
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a form of arthritis that causes pain, swelling, and stiffness in your joints. RA is an autoimmune disease. Although it is most common in the wrist and fingers, this disease can cause your immune system to attack any joint tissue. The inflammation (swelling) that comes with RA can also affect other body parts.

The full article covers:

  • What is rheumatoid arthritis?
  • Who is more likely to get rheumatoid arthritis?
  • What causes rheumatoid arthritis?
  • What are the symptoms of rheumatoid arthritis?
  • How is rheumatoid arthritis diagnosed?
  • What are the treatments for rheumatoid arthritis?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert M05.019 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
714.1 Felty's syndrome
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About M05.019Overview

What is the ICD-10 code for Felty's syndrome, unspecified shoulder?

The ICD-10-CM code for Felty's syndrome, unspecified shoulder is M05.019 (sometimes written as M05019). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

Is M05.019 (Felty's syndrome, shoulder) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report Felty's syndrome, unspecified shoulder on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does M05.019 group to?

When Felty's syndrome, unspecified shoulder is the principal diagnosis on an inpatient stay, it groups to MS-DRG 545, 546, 547, with relative weights from 0.8362 to 2.4817 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of M05.019?

Under the General Equivalence Mappings, Felty's syndrome, unspecified shoulder converts to ICD-9-CM 714.1 (Felty's syndrome). The mapping is approximate, so confirm the match fits the documentation.

What HCC is M05.019?

M05.019 (Felty's syndrome, unspecified shoulder) maps to CMS-HCC Category 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders), commonly written as HCC 93, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 40 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 83.

Does M05.019 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, M05.019 adds a risk adjustment factor of about 0.617 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.288 to 0.617 depending on the payment segment). HCC 93 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 93 category page.