M23.611
BillableOther spontaneous disruption of anterior cruciate ligament of right knee
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M23.611 an HCC code?
No. M23.611 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
M23.611 is the ICD-10-CM diagnosis code for other spontaneous disruption of anterior cruciate ligament of right knee. A tear or rupture of the anterior cruciate ligament (ACL) in the right knee that occurs suddenly without a major injury. M23.611 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering other joint disorders (m20-m25).
M23.611 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.
Verify laterality is documented as right knee; if not specified, use M23.619 instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M23.611 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.