2026 ICD-10-CM Diagnosis Code T85.49XAOther mechanical complication of breast prosthesis and implant, initial encounter

ICD-10-CM Codes›S00–T88›T80-T88›T85

ICD-10-CM T85.49XA
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

T85.49XA is a billable ICD-10-CM diagnosis code for other mechanical complication of breast prosthesis and implant, initial encounter. The 7th character A marks it as an initial encounter code, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 600 through 601. Coders also document this condition as breakage of prosthesis. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Complication of other surgical or medical care, injury, initial encounter.

Code Identity

ICD-10-CM Code
T85.49XA
Billable Status
Yes — Valid for Submission
Code Describes
Other mechanical complication of breast prosthesis and implant, initial encounter
Short Description
Mech compl of breast prosthesis and implant, init encntr
Parent Code
T85.49
Other mechanical complication of breast prosthesis and implant

Code Classification

ChapterS00–T88Injury, poisoning and certain other consequences of external causes
SectionT80-T88Complications of surgical and medical care, not elsewhere classified
CategoryT85Complications of other internal prosthetic devices, implants and grafts
This CodeT85.49XAOther mechanical complication of breast prosthesis and implant, initial encounter

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Breakage of prosthesis
  • Pain associated with breast implant
  • Pain associated with internal prosthetic device
  • Protrusion of prosthetic breast implant
  • Rippling of surface of breast associated with prosthetic breast implant
  • Rupture of breast implant
  • Rupture of left breast implant
  • Rupture of right breast implant

Coding GuidelinesGuidance

The appropriate 7th character is to be added to each code from block Complications of other internal prosthetic devices, implants and grafts (T85). Use the following options for the applicable episode of care:

  • A - initial encounter
  • D - subsequent encounter
  • S - sequela

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026, published by CMS and the National Center for Health Statistics.

Clinical ClassificationClinical

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

CCSR INJ037
Complication of other surgical or medical care, injury, initial encounter
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Breast Reconstruction

If you need a mastectomy, you have a choice about whether or not to have surgery to rebuild the shape of the breast. Instead of breast reconstruction, you could choose to wear a breast form that replaces the breast, wear padding inside your bra, or do nothing. All of these options have pros and cons.

Read the full article at MedlinePlus

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

Convert T85.49XA to ICD-9-CMHistory

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

ICD-9-CM
996.54 Breast prosth malfunc
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 T85.49XAOverview

Is T85.49XA a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report other mechanical complication of breast prosthesis and implant, initial encounter on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What does the 7th character A in T85.49XA mean?

The final character A marks the initial encounter: use it while the patient is receiving active treatment for other mechanical complication of breast prosthesis and implant, such as an emergency visit or first evaluation.

What MS-DRG does T85.49XA group to?

When other mechanical complication of breast prosthesis and implant, initial encounter is the principal diagnosis on an inpatient stay, it groups to MS-DRG 600, 601, with relative weights from 0.6050 to 1.0416 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of T85.49XA?

Under the General Equivalence Mappings, other mechanical complication of breast prosthesis and implant, initial encounter converts to ICD-9-CM 996.54 (breast prosth malfunc). The mapping is approximate, so confirm the match fits the documentation.