M60.819
BillableOther myositis, unspecified shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M60.819 an HCC code?
No. M60.819 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
M60.819 is the ICD-10-CM diagnosis code for other myositis, unspecified shoulder. Inflammation of muscle tissue in the shoulder area, when the specific shoulder is not identified. M60.819 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering disorders of muscles (m60-m63).
M60.819 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.
Use this code only when documentation does not specify right or left shoulder; consider querying provider for laterality.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M60.819 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 documentation does not specify right or left shoulder; consider querying provider for laterality
- •Verify if a more specific myositis type (infectious, traumatic, or idiopathic) is documented to ensure correct code selection