M48.8X6 ICD-10-CM Code: Other specified spondylopathies, lumbar region
M48.8X6 maps to CMS-HCC V28 93. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Spondylopathies (M45-M49)
M48.8X6
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther specified spondylopathies, lumbar region
A rare or unusual spine disease affecting the lower back (lumbar) region of the spine.
Buddy Insight
Other specified spondylopathies in the lumbar region affect the lower back, the most mobile portion of the spine subject to highest biomechanical loads.
CMS-HCC V28
MappedHCC 93
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 056
Code-level coefficient reference
ESRD/PACE
MappedHCC 40
Code-level coefficient reference
RXHCC
MappedHCC 83
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Ossification of posterior longitudinal ligamentInherited from M48.8
Excludes 2
Official- arthropathic psoriasis (L40.5-)Inherited from M00-M99
- certain conditions originating in the perinatal period (P04-P96)Inherited from M00-M99
- certain infectious and parasitic diseases (A00-B99)Inherited from M00-M99
- compartment syndrome (traumatic) (T79.A-)Inherited from M00-M99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from M00-M99
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from M00-M99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from M00-M99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from M00-M99
- neoplasms (C00-D49)Inherited from M00-M99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from M00-M99
Related Codes
Includes
OfficialNo Includes notes are included in this display for M48.8X6. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for M48.8X6. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for M48.8X6. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for M48.8X6. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for M48.8X6. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 M48.8X6 an HCC code?
Yes. M48.8X6 (Other specified spondylopathies, lumbar region) maps to HCC 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.617. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: M48.8X6 is billable and maps to V28 HCC 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- M48.8X6
- Description
- Other specified spondylopathies, lumbar region
- HCC (V28)
- HCC 93 — Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders
- RAF reference coefficient
- 0.617
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work M48.8X6 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for M48.8X6
For M48.8X6, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
M48.8X6 is the ICD-10-CM diagnosis code for other specified spondylopathies, lumbar region. A rare or unusual spine disease affecting the lower back (lumbar) region of the spine. M48.8X6 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, M48.8X6 maps to Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders (HCC 93) with a source-labeled community, non-dual, aged reference coefficient of 0.617. No V24 mapping is shown for M48.8X6; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Ensure the condition is documented as lumbar-specific and doesn't extend to the sacral region. For M48.8X6, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for M48.8X6 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure the condition is documented as lumbar-specific and doesn't extend to the sacral region
- •Differentiate from M48.8X7 which includes lumbosacral involvement
Clinical Significance
Other specified spondylopathies in the lumbar region affect the lower back, the most mobile portion of the spine subject to highest biomechanical loads. Lumbar involvement commonly causes significant functional disability and may lead to nerve root compression.
Documentation Requirements
- ✓Specific spondylopathy affecting L1-L5 vertebrae
- ✓Imaging studies demonstrating lumbar spine pathology
- ✓Assessment for nerve root compression or cauda equina involvement
- ✓Documentation of unique spondylopathy not fitting other specific categories
- ✓Functional assessment including walking tolerance and lifting capacity
- ✓Pain assessment using validated scales
- ✓Treatment response and work/activity limitations
Commonly Confused Codes
- •M48.8X5: Other specified spondylopathies thoracolumbar (use for T12-L1 transition)
- •M48.8X7: Other specified spondylopathies lumbosacral (use for L5-S1 junction)
- •M43.16: Spondylolisthesis lumbar region (use when vertebral slippage documented)
- •M47.26: Other spondylosis with radiculopathy lumbar region (use for degenerative disease)