Question 1

What is ICD-10 code M48.061?

Accepted Answer

M48.061 is the ICD-10-CM diagnosis code for spinal stenosis, lumbar region without neurogenic claudication. Narrowing of the spinal canal in the lower back (lumbar region) without neurogenic claudication, meaning leg pain with walking is not present. M48.061 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).

M48.061 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.

Neurogenic claudication (leg pain/weakness with walking that improves with rest) is a key distinguishing feature; if absent, use this code.

Question 2

Is M48.061 an HCC code?

Accepted Answer

No. M48.061 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is M48.061 billable?

Accepted Answer

Yes. M48.061 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. M48.061 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for M48.061?

Accepted Answer

M48.061 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards M48.061 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting M48.061?

Accepted Answer

Neurogenic claudication (leg pain/weakness with walking that improves with rest) is a key distinguishing feature; if absent, use this code Document whether patient has back pain, leg pain, or both to support the diagnosis

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M48.061

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M48.061 ICD-10-CM Code: Spinal stenosis, lumbar region without neurogenic claudication

HCC Buddy Code Card

M48.061

Is M48.061 an HCC code?

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Work M48.061 in HCC Buddy