2026 ICD-10-CM Diagnosis Code M46.07Spinal enthesopathy, lumbosacral region
ICD-10-CM Codes›M00–M99›M45-M49›M46
- Billable — Valid for Submission
- Chronic Condition
M46.07 is a billable ICD-10-CM diagnosis code for spinal enthesopathy, lumbosacral region. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 551 through 552. Coders also document this condition as spinal enthesopathy. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Spondylopathies/spondyloarthropathy (including infective).
M46.07 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
M46.07 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.
- Spinal enthesopathy
- Spinal enthesopathy of lumbar region
- Spinal enthesopathy of lumbosacral region
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Connective Tissue Disorders
Your connective tissue supports many different parts of your body, such as your skin, eyes, and heart. It is like a "cellular glue" that gives your body parts their shape and helps keep them strong. It also helps some of your tissues do their work. It is made of many kinds of proteins. Cartilage and fat are types of connective tissue.
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Convert M46.07 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M46.07Overview
What is the ICD-10 code for spinal enthesopathy, lumbosacral region?
The ICD-10-CM code for spinal enthesopathy, lumbosacral region is M46.07 (sometimes written as M4607). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is M46.07 (Spinal enthesopathy) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report spinal enthesopathy, lumbosacral region on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does M46.07 group to?
When spinal enthesopathy, lumbosacral region is the principal diagnosis on an inpatient stay, it groups to MS-DRG 551, 552, with relative weights from 0.9613 to 1.6761 depending on complications. Higher weights mean higher Medicare reimbursement.
What is the ICD-9 equivalent of M46.07?
Under the General Equivalence Mappings, spinal enthesopathy, lumbosacral region converts to ICD-9-CM 720.1 (spinal enthesopathy). The mapping is approximate, so confirm the match fits the documentation.
Does M46.07 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage. M46.07 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).
