M65.811 ICD-10-CM Code: Other synovitis and tenosynovitis, right shoulder
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Disorders of synovium and tendon (M65-M67)
M65.811
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther synovitis and tenosynovitis, right shoulder
Inflammation of the tissue surrounding tendons or the joint lining in the right shoulder.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for M65.811 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M65.811 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M65.811 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M65.811 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M65.811 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M65.811 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M65.811 in this effective period.
Buddy Documentation Tip
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 M65.811 an HCC code?
No. M65.811 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- M65.811
- Description
- Other synovitis and tenosynovitis, right shoulder
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
M65.811 is the ICD-10-CM diagnosis code for other synovitis and tenosynovitis, right shoulder. Inflammation of the tissue surrounding tendons or the joint lining in the right shoulder. M65.811 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering disorders of synovium and tendon (m65-m67).
M65.811 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.
Confirm the affected site is the right shoulder before assigning this code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M65.811 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm the affected site is the right shoulder before assigning this code
- •Use M65.812 if the condition affects the left shoulder instead