M13.162
BillableMonoarthritis, not elsewhere classified, left knee
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M13.162 an HCC code?
No. M13.162 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
M13.162 is the ICD-10-CM diagnosis code for monoarthritis, not elsewhere classified, left knee. Inflammation of a single joint in the left knee without a specific identified cause. M13.162 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering inflammatory polyarthropathies (m05-m14).
M13.162 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Use this code for monoarthritis of the left knee when the underlying cause is unknown or not elsewhere classified.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M13.162 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.