M48.05 ICD-10-CM Code: Spinal stenosis, thoracolumbar region
M48.05 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Spondylopathies (M45-M49)
M48.05
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSpinal stenosis, thoracolumbar region
Narrowing of the spinal canal at the junction between the mid-back and lower back (thoracolumbar region).
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Caudal stenosis
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M48.05 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M48.05 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M48.05 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M48.05 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M48.05 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M48.05 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is M48.05 an HCC code?
No. M48.05 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- M48.05
- Description
- Spinal stenosis, thoracolumbar region
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
M48.05 is the ICD-10-CM diagnosis code for spinal stenosis, thoracolumbar region. Narrowing of the spinal canal at the junction between the mid-back and lower back (thoracolumbar region). M48.05 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).
M48.05 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28, V24, ESRD, or RxHCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.
Use this code when stenosis involves both thoracic and lumbar regions at the transition point.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for M48.05 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when stenosis involves both thoracic and lumbar regions at the transition point
- •Document the extent of involvement to justify treatment decisions