M65.919
BillableUnspecified synovitis and tenosynovitis, unspecified shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M65.919 an HCC code?
No. M65.919 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
M65.919 is the ICD-10-CM diagnosis code for unspecified synovitis and tenosynovitis, unspecified shoulder. Inflammation of the tissue lining tendons and joints in the shoulder when the specific side (right or left) is not documented or is bilateral. This causes pain, swelling, and reduced shoulder mobility. M65.919 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).
M65.919 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 when laterality cannot be determined from documentation.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M65.919 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when laterality cannot be determined from documentation
- •Query the provider if possible to determine if the condition is unilateral or bilateral for more specific coding