M49.89
BillableSpondylopathy in diseases classified elsewhere, multiple sites in spine
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M49.89 an HCC code?
Yes. M49.89 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease under the V24 model but is not retained in V28.
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 M49.89
For M49.89to 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 M49.89 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M49.89 is the ICD-10-CM diagnosis code for spondylopathy in diseases classified elsewhere, multiple sites in spine. Spine disease affecting multiple areas of the spine caused by another medical condition classified elsewhere. M49.89 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 older CMS-HCC V24 model, M49.89 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease (HCC 40) with a community, non-dual, aged base RAF weight of 0.307. 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 when spondylopathy involves more than one spinal region. Because M49.89 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 M49.89 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when spondylopathy involves more than one spinal region
- •Always identify and code the underlying disease causing the condition
Clinical Significance
Multiple site spinal involvement secondary to another classified disease indicates extensive systemic pathology with widespread skeletal manifestations, representing the most complex scenario requiring multidisciplinary care. This suggests advanced disease progression with significant functional impact and care coordination needs.
Documentation Requirements
- ✓Documentation of spondylopathy affecting multiple spine sites
- ✓Clear identification and coding of underlying causative disease
- ✓Imaging evidence of multi-level spinal involvement
- ✓Clinical examination findings at multiple spine levels
- ✓Documentation of secondary nature 'in diseases classified elsewhere'
- ✓Comprehensive functional assessment across spine regions
- ✓Evidence of systemic disease progression