M45.AB
BillableNon-radiographic axial spondyloarthritis of multiple sites in spine
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M45.AB an HCC code?
Yes. M45.AB maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease 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.AB
For M45.ABto 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.AB during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M45.AB is the ICD-10-CM diagnosis code for non-radiographic axial spondyloarthritis of multiple sites in spine. Inflammation affecting multiple joints throughout the spine that doesn't show typical changes on standard X-rays. M45.AB 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.AB maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease (HCC 93) with a community, non-dual, aged base RAF weight of 0.175. Under the older V24 model, M45.AB mapped to the same category but with a base RAF weight of 0.307 — V28 recalibrated weights across the entire model. 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.
Use this code only when the condition involves multiple non-contiguous spinal regions. Because M45.AB 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.AB sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the condition involves multiple non-contiguous spinal regions
- •Document which specific spinal regions are affected to support medical necessity and treatment planning
Clinical Significance
Non-radiographic axial spondyloarthritis affecting multiple spinal sites represents extensive early disease with high potential for progression to structural damage. This pattern requires aggressive immunosuppressive therapy and intensive monitoring to preserve spinal function.
Documentation Requirements
- ✓MRI evidence of inflammation at multiple spinal levels
- ✓Absence of widespread structural changes on conventional imaging
- ✓Clinical symptoms involving multiple spinal regions
- ✓Comprehensive spinal mobility assessment
- ✓Documentation of disease extent and distribution
- ✓Response to systemic biologic therapy
- ✓Disease activity measures across multiple domains
- ✓Assessment for extra-articular manifestations
Commonly Confused Codes
- •M45.9 — Radiographic ankylosing spondylitis when structural changes present
- •Individual site-specific codes when multiple sites should be combined
- •M46.90 — Unspecified inflammatory spondylopathy without axial features
- •M48.10 — Ankylosing hyperostosis without inflammatory component
- •M53.9 — Unspecified dorsopathy without inflammatory characteristics