M85.319
BillableOsteitis condensans, unspecified shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M85.319 an HCC code?
No. M85.319 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
M85.319 is the ICD-10-CM diagnosis code for osteitis condensans, unspecified shoulder. A bone condition affecting the shoulder with increased bone density and hardening, but the specific side (left or right) is not specified. M85.319 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).
M85.319 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 shoulder involvement is confirmed but laterality cannot be determined from documentation.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M85.319 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 shoulder involvement is confirmed but laterality cannot be determined from documentation
- •Query the provider if possible to determine whether the condition is unilateral or bilateral