M45.A5
BillableNon-radiographic axial spondyloarthritis of thoracolumbar region
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M45.A5 an HCC code?
Yes. M45.A5 maps to Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders under the CMS-HCC V28 risk adjustment model (and Rheumatoid Arthritis and Inflammatory Connective Tissue Disease under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for M45.A5
For M45.A5to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed M45.A5 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M45.A5 is the ICD-10-CM diagnosis code for non-radiographic axial spondyloarthritis of thoracolumbar region. Inflammation of the spine joints where the mid-back and lower back meet that doesn't show typical changes on standard X-rays. M45.A5 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering spondylopathies (m45-m49).
Under the CMS-HCC V28 risk adjustment model, M45.A5 maps to Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders (HCC 93) with a community, non-dual, aged base RAF weight of 0.617. Under the older CMS-HCC V24 model, M45.A5 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease (HCC 40) with a community, non-dual, aged base RAF weight of 0.421. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Verify documentation specifies the thoracolumbar junction involvement rather than isolated thoracic or lumbar regions. Because M45.A5 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M45.A5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies the thoracolumbar junction involvement rather than isolated thoracic or lumbar regions
- •May require imaging studies other than standard X-rays (MRI, CT) to confirm diagnosis
Clinical Significance
Non-radiographic axial spondyloarthritis at the thoracolumbar junction affects the transition point between the rigid thoracic cage and mobile lumbar spine, creating unique biomechanical stress. This location often correlates with severe functional limitations despite absence of radiographic changes.
Documentation Requirements
- ✓MRI evidence of inflammation at thoracolumbar junction
- ✓Absence of structural changes on plain films
- ✓Clinical symptoms spanning mid to lower back
- ✓Assessment of spinal mobility in both planes
- ✓Documentation of functional impact on daily activities
- ✓Pain patterns involving thoracolumbar transition
- ✓Response to biologic or targeted synthetic DMARD therapy
- ✓Evaluation for enthesitis at multiple sites