2026 ICD-10-CM Diagnosis Code M48.8X5Other specified spondylopathies, thoracolumbar region
ICD-10-CM Codes›M00–M99›M45-M49›M48
- Billable — Valid for Submission
- Risk Adjusts — HCC 93
- Chronic Condition
M48.8X5 is a billable ICD-10-CM diagnosis code for other specified spondylopathies, thoracolumbar region. 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 and Spondylopathies/spondyloarthropathy (including infective).
For Medicare Advantage risk adjustment, M48.8X5 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
Code Classification
Medicare Risk Adjustment (HCC)Billing
M48.8X5 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.
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.
Patient EducationClinical
Spine Injuries and Disorders
Your backbone, or spine, is made up of 26 bone discs called vertebrae. The vertebrae protect your spinal cord and allow you to stand and bend. A number of problems can change the structure of the spine or damage the vertebrae and surrounding tissue. They include:
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert M48.8X5 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M48.8X5Overview
What is the ICD-10 code for other specified spondylopathies, thoracolumbar region?
The ICD-10-CM code for other specified spondylopathies, thoracolumbar region is M48.8X5 (sometimes written as M488X5). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is M48.8X5 (Other specified spondylopathies) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other specified spondylopathies, thoracolumbar region on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does M48.8X5 group to?
When other specified spondylopathies, thoracolumbar region 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 M48.8X5?
Under the General Equivalence Mappings, other specified spondylopathies, thoracolumbar region converts to ICD-9-CM 720.0 (ankylosing spondylitis). The mapping is approximate, so confirm the match fits the documentation.
What HCC is M48.8X5?
M48.8X5 (other specified spondylopathies, thoracolumbar region) 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 M48.8X5 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, M48.8X5 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.
