2026 ICD-10-CM Diagnosis Code M35.3Polymyalgia rheumatica
ICD-10-CM Codes›M00–M99›M30-M36›M35
- Billable — Valid for Submission
- Chronic Condition
M35.3 is a billable ICD-10-CM diagnosis code for polymyalgia rheumatica. 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. Coders also document this condition as polymyalgia. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Systemic lupus erythematosus and connective tissue disorders.
M35.3 no longer risk-adjusts for Medicare Advantage: it mapped to HCC 40 under the retired CMS-HCC V24 model through payment year 2025 but maps to no category in the live V28 model. It still risk-adjusts in the PACE (CMS-HCC V22) category 40, ESRD (V21) category 40, and ESRD (V24) category 40 for payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
M35.3 no longer risk-adjusts for Medicare Advantage: it maps to no payment category in the live CMS-HCC V28 model, although it still risk-adjusts in the other CMS models shown below.
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.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Polymyalgia
- Polymyalgia rheumatica
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Type 1 Excludes
- polymyalgia rheumatica with giant cell arteritis M31.5
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Disease, diseased See Also: Syndrome;
Polymyalgia M35.3
rheumatica M35.3
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Polymyalgia Rheumatica
a syndrome in the elderly characterized by proximal joint and muscle pain, high erythrocyte sedimentation rate, and a self-limiting course. pain is usually accompanied by evidence of an inflammatory reaction. women are affected twice as commonly as men and caucasians more frequently than other groups. the condition is frequently associated with giant cell arteritis and some theories pose the possibility that the two diseases arise from a single etiology or even that they are the same entity.Giant Cell Arteritis
a systemic autoimmune disorder that typically affects medium and large arteries, usually leading to occlusive granulomatous vasculitis with transmural infiltrate containing multinucleated giant cells. the temporal artery is commonly involved. this disorder appears primarily in people over the age of 50. symptoms include fever; fatigue; headache; visual impairment; pain in the jaw and tongue; and aggravation of pain by cold temperatures. (from adams et al., principles of neurology, 6th ed)
Patient EducationClinical
Polymyalgia Rheumatica
Polymyalgia rheumatica is a disorder that causes muscle pain and stiffness in your neck, shoulders, and hips. It is most common in women and almost always occurs in people over 50. The main symptom is stiffness after resting. Other symptoms include fever, weakness and weight loss. In some cases, polymyalgia rheumatica develops overnight.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert M35.3 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M35.3Overview
What is the ICD-10 code for polymyalgia rheumatica?
The ICD-10-CM code for polymyalgia rheumatica is M35.3 (sometimes written as M353). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is M35.3 (Other systemic involvement of connective tissue) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report polymyalgia rheumatica on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does M35.3 group to?
When polymyalgia rheumatica 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 M35.3?
Under the General Equivalence Mappings, polymyalgia rheumatica converts to ICD-9-CM 725 (polymyalgia rheumatica). The mapping is a direct match.
Does M35.3 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage. M35.3 mapped to HCC 40 in the retired CMS-HCC V24 model, which last determined payment in 2025, but it maps to no category in the live V28 model; see all codes that no longer risk-adjust. It still risk-adjusts in the PACE (CMS-HCC V22) category 40 (Rheumatoid Arthritis and Inflammatory Connective Tissue Disease), ESRD (V21) category 40 (Rheumatoid Arthritis and Inflammatory Connective Tissue Disease), and ESRD (V24) category 40 (Rheumatoid Arthritis and Inflammatory Connective Tissue Disease).
