M61.169
BillableMyositis ossificans progressiva, unspecified lower leg
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M61.169 an HCC code?
No. M61.169 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
M61.169 is the ICD-10-CM diagnosis code for myositis ossificans progressiva, unspecified lower leg. A rare genetic condition where muscle tissue in the lower leg gradually turns into bone, but the specific side (left or right) is not documented or is bilateral. M61.169 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).
M61.169 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 when laterality cannot be determined or when both lower legs are affected.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M61.169 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use when laterality cannot be determined or when both lower legs are affected
- •Request clarification from provider if unilateral involvement can be confirmed