M81.6 ICD-10-CM Code: Localized osteoporosis [Lequesne]
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Disorders of bone density and structure (M80-M85)
M81.6
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLocalized osteoporosis [Lequesne]
Localized weakening of bones in a specific area of the body, making that region more fragile and prone to breaking.
Buddy Insight
Localized osteoporosis represents regional bone density loss in specific anatomical areas, often indicating more complex pathophysiology than generalized osteoporosis.
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
MappedHCC 87
RAF 0.055
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for M81.6 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M81.6 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M81.6 in this effective period.
Excludes 1
Official- Sudeck's atrophy (M89.0)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M81.6 in this effective period.
Use Additional
Official- code to identify:
- major osseous defect, if applicable (M89.7-)
- personal history of (healed) osteoporosis fracture, if applicable (Z87.310)
Code Also
OfficialICD-10-CM does not list Code Also instructions for M81.6 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is M81.6 an HCC code?
M81.6 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Osteoporosis, Vertebral and Pathological Fractures under the Part D RxHCC model.
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.
Work M81.6 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for M81.6
For M81.6to 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 M81.6 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
M81.6 is the ICD-10-CM diagnosis code for localized osteoporosis [lequesne]. Localized weakening of bones in a specific area of the body, making that region more fragile and prone to breaking. M81.6 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering disorders of bone density and structure (m80-m85).
M81.6 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.
This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing M81.6 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M81.6 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify the site of localized osteoporosis when documented (vertebra, hip, etc.)
- •This code is used when osteoporosis is limited to one region rather than generalized
Clinical Significance
Localized osteoporosis represents regional bone density loss in specific anatomical areas, often indicating more complex pathophysiology than generalized osteoporosis. This condition requires targeted evaluation for local factors and may indicate underlying conditions affecting regional bone metabolism.
Documentation Requirements
- ✓Documentation of localized bone density loss in specific region
- ✓Clinical or radiographic evidence of regional osteoporosis
- ✓Specification of anatomical location if documented
- ✓Exclusion of generalized osteoporosis
- ✓Assessment of local contributing factors
- ✓Absence of current pathological fracture
- ✓Investigation for underlying regional pathology
Excludes 1, Do NOT code together
- Sudeck's atrophy (M89.0)