Question 1

What is ICD-10 code M94.8X1?

Accepted Answer

M94.8X1 is the ICD-10-CM diagnosis code for other specified disorders of cartilage, shoulder. Other types of cartilage disorders affecting the shoulder joint that do not fit into standard chondromalacia or chondrolysis categories. M94.8X1 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering chondropathies (m91-m94).

M94.8X1 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.

Specify which shoulder (right or left) in documentation; the code structure may require additional laterality specification.

Question 2

Is M94.8X1 an HCC code?

Accepted Answer

No. M94.8X1 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is M94.8X1 billable?

Accepted Answer

Yes. M94.8X1 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. M94.8X1 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for M94.8X1?

Accepted Answer

M94.8X1 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards M94.8X1 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting M94.8X1?

Accepted Answer

Specify which shoulder (right or left) in documentation; the code structure may require additional laterality specification Use when shoulder cartilage pathology is present but does not meet criteria for more specific codes

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M94.8X1

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M94.8X1 ICD-10-CM Code: Other specified disorders of cartilage, shoulder

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M94.8X1

Is M94.8X1 an HCC code?

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