FUTURE LCD Reference Article Billing and Coding Article

Billing and Coding: Total Shoulder Arthroplasty

A59878

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Source Article ID
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Article ID
A59878
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Total Shoulder Arthroplasty
Article Type
Billing and Coding
Original Effective Date
01/26/2025
Revision Effective Date
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Revision Ending Date
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Retirement Date
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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, §3.4.1.3 Diagnosis Code Requirements

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Total Shoulder Arthroplasty L39956.

Documentation Requirements:

  • All documentation must be maintained in the patient's medical record and must support the medical necessity of the services as directed in this article and be made available to the contractor upon request.

  • The patient's medical record must contain documentation that fully supports the medical necessity for services included in the LCD. (See Coverage Indications, Limitations and/or Medical Necessity.) This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(272 Codes)
Group 1 Paragraph

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Group 1 Codes
Code Description
C40.01 Malignant neoplasm of scapula and long bones of right upper limb
C40.02 Malignant neoplasm of scapula and long bones of left upper limb
C43.61 Malignant melanoma of right upper limb, including shoulder
C43.62 Malignant melanoma of left upper limb, including shoulder
C44.602 Unspecified malignant neoplasm of skin of right upper limb, including shoulder
C44.609 Unspecified malignant neoplasm of skin of left upper limb, including shoulder
C49.11 Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder
C49.12 Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder
C76.41 Malignant neoplasm of right upper limb
C76.42 Malignant neoplasm of left upper limb
D03.61 Melanoma in situ of right upper limb, including shoulder
D03.62 Melanoma in situ of left upper limb, including shoulder
M05.011 Felty's syndrome, right shoulder
M05.012 Felty's syndrome, left shoulder
M12.011 Chronic postrheumatic arthropathy [Jaccoud], right shoulder
M12.012 Chronic postrheumatic arthropathy [Jaccoud], left shoulder
M12.511 Traumatic arthropathy, right shoulder
M12.512 Traumatic arthropathy, left shoulder
M12.811 Other specific arthropathies, not elsewhere classified, right shoulder
M12.812 Other specific arthropathies, not elsewhere classified, left shoulder
M19.011 Primary osteoarthritis, right shoulder
M19.012 Primary osteoarthritis, left shoulder
M19.111 Post-traumatic osteoarthritis, right shoulder
M19.112 Post-traumatic osteoarthritis, left shoulder
M19.211 Secondary osteoarthritis, right shoulder
M19.212 Secondary osteoarthritis, left shoulder
M24.811 Other specific joint derangements of right shoulder, not elsewhere classified
M24.812 Other specific joint derangements of left shoulder, not elsewhere classified
M75.101 Unspecified rotator cuff tear or rupture of right shoulder, not specified as traumatic
M75.102 Unspecified rotator cuff tear or rupture of left shoulder, not specified as traumatic
M75.111 Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic
M75.112 Incomplete rotator cuff tear or rupture of left shoulder, not specified as traumatic
M75.121 Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic
M75.122 Complete rotator cuff tear or rupture of left shoulder, not specified as traumatic
M87.021 Idiopathic aseptic necrosis of right humerus
M87.022 Idiopathic aseptic necrosis of left humerus
S42.031K Displaced fracture of lateral end of right clavicle, subsequent encounter for fracture with nonunion
S42.031P Displaced fracture of lateral end of right clavicle, subsequent encounter for fracture with malunion
S42.032K Displaced fracture of lateral end of left clavicle, subsequent encounter for fracture with nonunion
S42.032P Displaced fracture of lateral end of left clavicle, subsequent encounter for fracture with malunion
S42.034K Nondisplaced fracture of lateral end of right clavicle, subsequent encounter for fracture with nonunion
S42.034P Nondisplaced fracture of lateral end of right clavicle, subsequent encounter for fracture with malunion
S42.035K Nondisplaced fracture of lateral end of left clavicle, subsequent encounter for fracture with nonunion
S42.035P Nondisplaced fracture of lateral end of left clavicle, subsequent encounter for fracture with malunion
S42.111K Displaced fracture of body of scapula, right shoulder, subsequent encounter for fracture with nonunion
S42.111P Displaced fracture of body of scapula, right shoulder, subsequent encounter for fracture with malunion
S42.112K Displaced fracture of body of scapula, left shoulder, subsequent encounter for fracture with nonunion
S42.112P Displaced fracture of body of scapula, left shoulder, subsequent encounter for fracture with malunion
S42.114K Nondisplaced fracture of body of scapula, right shoulder, subsequent encounter for fracture with nonunion
S42.114P Nondisplaced fracture of body of scapula, right shoulder, subsequent encounter for fracture with malunion
S42.115K Nondisplaced fracture of body of scapula, left shoulder, subsequent encounter for fracture with nonunion
S42.115P Nondisplaced fracture of body of scapula, left shoulder, subsequent encounter for fracture with malunion
S42.121K Displaced fracture of acromial process, right shoulder, subsequent encounter for fracture with nonunion
S42.121P Displaced fracture of acromial process, right shoulder, subsequent encounter for fracture with malunion
S42.122K Displaced fracture of acromial process, left shoulder, subsequent encounter for fracture with nonunion
S42.122P Displaced fracture of acromial process, left shoulder, subsequent encounter for fracture with malunion
S42.124K Nondisplaced fracture of acromial process, right shoulder, subsequent encounter for fracture with nonunion
S42.124P Nondisplaced fracture of acromial process, right shoulder, subsequent encounter for fracture with malunion
S42.125K Nondisplaced fracture of acromial process, left shoulder, subsequent encounter for fracture with nonunion
S42.125P Nondisplaced fracture of acromial process, left shoulder, subsequent encounter for fracture with malunion
S42.131K Displaced fracture of coracoid process, right shoulder, subsequent encounter for fracture with nonunion
S42.131P Displaced fracture of coracoid process, right shoulder, subsequent encounter for fracture with malunion
S42.132K Displaced fracture of coracoid process, left shoulder, subsequent encounter for fracture with nonunion
S42.132P Displaced fracture of coracoid process, left shoulder, subsequent encounter for fracture with malunion
S42.134K Nondisplaced fracture of coracoid process, right shoulder, subsequent encounter for fracture with nonunion
S42.134P Nondisplaced fracture of coracoid process, right shoulder, subsequent encounter for fracture with malunion
S42.135K Nondisplaced fracture of coracoid process, left shoulder, subsequent encounter for fracture with nonunion
S42.135P Nondisplaced fracture of coracoid process, left shoulder, subsequent encounter for fracture with malunion
S42.141K Displaced fracture of glenoid cavity of scapula, right shoulder, subsequent encounter for fracture with nonunion
S42.141P Displaced fracture of glenoid cavity of scapula, right shoulder, subsequent encounter for fracture with malunion
S42.142K Displaced fracture of glenoid cavity of scapula, left shoulder, subsequent encounter for fracture with nonunion
S42.142P Displaced fracture of glenoid cavity of scapula, left shoulder, subsequent encounter for fracture with malunion
S42.144K Nondisplaced fracture of glenoid cavity of scapula, right shoulder, subsequent encounter for fracture with nonunion
S42.144P Nondisplaced fracture of glenoid cavity of scapula, right shoulder, subsequent encounter for fracture with malunion
S42.145K Nondisplaced fracture of glenoid cavity of scapula, left shoulder, subsequent encounter for fracture with nonunion
S42.145P Nondisplaced fracture of glenoid cavity of scapula, left shoulder, subsequent encounter for fracture with malunion
S42.151K Displaced fracture of neck of scapula, right shoulder, subsequent encounter for fracture with nonunion
S42.151P Displaced fracture of neck of scapula, right shoulder, subsequent encounter for fracture with malunion
S42.152K Displaced fracture of neck of scapula, left shoulder, subsequent encounter for fracture with nonunion
S42.152P Displaced fracture of neck of scapula, left shoulder, subsequent encounter for fracture with malunion
S42.154K Nondisplaced fracture of neck of scapula, right shoulder, subsequent encounter for fracture with nonunion
S42.154P Nondisplaced fracture of neck of scapula, right shoulder, subsequent encounter for fracture with malunion
S42.155K Nondisplaced fracture of neck of scapula, left shoulder, subsequent encounter for fracture with nonunion
S42.155P Nondisplaced fracture of neck of scapula, left shoulder, subsequent encounter for fracture with malunion
S42.191K Fracture of other part of scapula, right shoulder, subsequent encounter for fracture with nonunion
S42.191P Fracture of other part of scapula, right shoulder, subsequent encounter for fracture with malunion
S42.192K Fracture of other part of scapula, left shoulder, subsequent encounter for fracture with nonunion
S42.192P Fracture of other part of scapula, left shoulder, subsequent encounter for fracture with malunion
S42.201A Unspecified fracture of upper end of right humerus, initial encounter for closed fracture
S42.201B Unspecified fracture of upper end of right humerus, initial encounter for open fracture
S42.201D Unspecified fracture of upper end of right humerus, subsequent encounter for fracture with routine healing
S42.201G Unspecified fracture of upper end of right humerus, subsequent encounter for fracture with delayed healing
S42.201K Unspecified fracture of upper end of right humerus, subsequent encounter for fracture with nonunion
S42.201P Unspecified fracture of upper end of right humerus, subsequent encounter for fracture with malunion
S42.201S Unspecified fracture of upper end of right humerus, sequela
S42.202A Unspecified fracture of upper end of left humerus, initial encounter for closed fracture
S42.202B Unspecified fracture of upper end of left humerus, initial encounter for open fracture
S42.202D Unspecified fracture of upper end of left humerus, subsequent encounter for fracture with routine healing
S42.202G Unspecified fracture of upper end of left humerus, subsequent encounter for fracture with delayed healing
S42.202K Unspecified fracture of upper end of left humerus, subsequent encounter for fracture with nonunion
S42.202P Unspecified fracture of upper end of left humerus, subsequent encounter for fracture with malunion
S42.202S Unspecified fracture of upper end of left humerus, sequela
S42.211A Unspecified displaced fracture of surgical neck of right humerus, initial encounter for closed fracture
S42.211B Unspecified displaced fracture of surgical neck of right humerus, initial encounter for open fracture
S42.211D Unspecified displaced fracture of surgical neck of right humerus, subsequent encounter for fracture with routine healing
S42.211G Unspecified displaced fracture of surgical neck of right humerus, subsequent encounter for fracture with delayed healing
S42.211K Unspecified displaced fracture of surgical neck of right humerus, subsequent encounter for fracture with nonunion
S42.211P Unspecified displaced fracture of surgical neck of right humerus, subsequent encounter for fracture with malunion
S42.211S Unspecified displaced fracture of surgical neck of right humerus, sequela
S42.212A Unspecified displaced fracture of surgical neck of left humerus, initial encounter for closed fracture
S42.212B Unspecified displaced fracture of surgical neck of left humerus, initial encounter for open fracture
S42.212D Unspecified displaced fracture of surgical neck of left humerus, subsequent encounter for fracture with routine healing
S42.212G Unspecified displaced fracture of surgical neck of left humerus, subsequent encounter for fracture with delayed healing
S42.212K Unspecified displaced fracture of surgical neck of left humerus, subsequent encounter for fracture with nonunion
S42.212P Unspecified displaced fracture of surgical neck of left humerus, subsequent encounter for fracture with malunion
S42.212S Unspecified displaced fracture of surgical neck of left humerus, sequela
S42.214A Unspecified nondisplaced fracture of surgical neck of right humerus, initial encounter for closed fracture
S42.214B Unspecified nondisplaced fracture of surgical neck of right humerus, initial encounter for open fracture
S42.214D Unspecified nondisplaced fracture of surgical neck of right humerus, subsequent encounter for fracture with routine healing
S42.214G Unspecified nondisplaced fracture of surgical neck of right humerus, subsequent encounter for fracture with delayed healing
S42.214K Unspecified nondisplaced fracture of surgical neck of right humerus, subsequent encounter for fracture with nonunion
S42.214P Unspecified nondisplaced fracture of surgical neck of right humerus, subsequent encounter for fracture with malunion
S42.214S Unspecified nondisplaced fracture of surgical neck of right humerus, sequela
S42.215A Unspecified nondisplaced fracture of surgical neck of left humerus, initial encounter for closed fracture
S42.215B Unspecified nondisplaced fracture of surgical neck of left humerus, initial encounter for open fracture
S42.215D Unspecified nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with routine healing
S42.215G Unspecified nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with delayed healing
S42.215K Unspecified nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with nonunion
S42.215P Unspecified nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with malunion
S42.215S Unspecified nondisplaced fracture of surgical neck of left humerus, sequela
S42.221A 2-part displaced fracture of surgical neck of right humerus, initial encounter for closed fracture
S42.221B 2-part displaced fracture of surgical neck of right humerus, initial encounter for open fracture
S42.221D 2-part displaced fracture of surgical neck of right humerus, subsequent encounter for fracture with routine healing
S42.221G 2-part displaced fracture of surgical neck of right humerus, subsequent encounter for fracture with delayed healing
S42.221K 2-part displaced fracture of surgical neck of right humerus, subsequent encounter for fracture with nonunion
S42.221P 2-part displaced fracture of surgical neck of right humerus, subsequent encounter for fracture with malunion
S42.221S 2-part displaced fracture of surgical neck of right humerus, sequela
S42.222A 2-part displaced fracture of surgical neck of left humerus, initial encounter for closed fracture
S42.222B 2-part displaced fracture of surgical neck of left humerus, initial encounter for open fracture
S42.222D 2-part displaced fracture of surgical neck of left humerus, subsequent encounter for fracture with routine healing
S42.222G 2-part displaced fracture of surgical neck of left humerus, subsequent encounter for fracture with delayed healing
S42.222K 2-part displaced fracture of surgical neck of left humerus, subsequent encounter for fracture with nonunion
S42.222P 2-part displaced fracture of surgical neck of left humerus, subsequent encounter for fracture with malunion
S42.222S 2-part displaced fracture of surgical neck of left humerus, sequela
S42.224A 2-part nondisplaced fracture of surgical neck of right humerus, initial encounter for closed fracture
S42.224B 2-part nondisplaced fracture of surgical neck of right humerus, initial encounter for open fracture
S42.224D 2-part nondisplaced fracture of surgical neck of right humerus, subsequent encounter for fracture with routine healing
S42.224G 2-part nondisplaced fracture of surgical neck of right humerus, subsequent encounter for fracture with delayed healing
S42.224K 2-part nondisplaced fracture of surgical neck of right humerus, subsequent encounter for fracture with nonunion
S42.224P 2-part nondisplaced fracture of surgical neck of right humerus, subsequent encounter for fracture with malunion
S42.224S 2-part nondisplaced fracture of surgical neck of right humerus, sequela
S42.225A 2-part nondisplaced fracture of surgical neck of left humerus, initial encounter for closed fracture
S42.225B 2-part nondisplaced fracture of surgical neck of left humerus, initial encounter for open fracture
S42.225D 2-part nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with routine healing
S42.225G 2-part nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with delayed healing
S42.225K 2-part nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with nonunion
S42.225P 2-part nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with malunion
S42.225S 2-part nondisplaced fracture of surgical neck of left humerus, sequela
S42.231A 3-part fracture of surgical neck of right humerus, initial encounter for closed fracture
S42.231B 3-part fracture of surgical neck of right humerus, initial encounter for open fracture
S42.231D 3-part fracture of surgical neck of right humerus, subsequent encounter for fracture with routine healing
S42.231G 3-part fracture of surgical neck of right humerus, subsequent encounter for fracture with delayed healing
S42.231K 3-part fracture of surgical neck of right humerus, subsequent encounter for fracture with nonunion
S42.231P 3-part fracture of surgical neck of right humerus, subsequent encounter for fracture with malunion
S42.231S 3-part fracture of surgical neck of right humerus, sequela
S42.232A 3-part fracture of surgical neck of left humerus, initial encounter for closed fracture
S42.232B 3-part fracture of surgical neck of left humerus, initial encounter for open fracture
S42.232D 3-part fracture of surgical neck of left humerus, subsequent encounter for fracture with routine healing
S42.232G 3-part fracture of surgical neck of left humerus, subsequent encounter for fracture with delayed healing
S42.232K 3-part fracture of surgical neck of left humerus, subsequent encounter for fracture with nonunion
S42.232P 3-part fracture of surgical neck of left humerus, subsequent encounter for fracture with malunion
S42.232S 3-part fracture of surgical neck of left humerus, sequela
S42.241A 4-part fracture of surgical neck of right humerus, initial encounter for closed fracture
S42.241B 4-part fracture of surgical neck of right humerus, initial encounter for open fracture
S42.241D 4-part fracture of surgical neck of right humerus, subsequent encounter for fracture with routine healing
S42.241G 4-part fracture of surgical neck of right humerus, subsequent encounter for fracture with delayed healing
S42.241K 4-part fracture of surgical neck of right humerus, subsequent encounter for fracture with nonunion
S42.241P 4-part fracture of surgical neck of right humerus, subsequent encounter for fracture with malunion
S42.241S 4-part fracture of surgical neck of right humerus, sequela
S42.242A 4-part fracture of surgical neck of left humerus, initial encounter for closed fracture
S42.242B 4-part fracture of surgical neck of left humerus, initial encounter for open fracture
S42.242D 4-part fracture of surgical neck of left humerus, subsequent encounter for fracture with routine healing
S42.242G 4-part fracture of surgical neck of left humerus, subsequent encounter for fracture with delayed healing
S42.242K 4-part fracture of surgical neck of left humerus, subsequent encounter for fracture with nonunion
S42.242P 4-part fracture of surgical neck of left humerus, subsequent encounter for fracture with malunion
S42.242S 4-part fracture of surgical neck of left humerus, sequela
S42.251A Displaced fracture of greater tuberosity of right humerus, initial encounter for closed fracture
S42.251B Displaced fracture of greater tuberosity of right humerus, initial encounter for open fracture
S42.251D Displaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with routine healing
S42.251G Displaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with delayed healing
S42.251K Displaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with nonunion
S42.251P Displaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with malunion
S42.251S Displaced fracture of greater tuberosity of right humerus, sequela
S42.252A Displaced fracture of greater tuberosity of left humerus, initial encounter for closed fracture
S42.252B Displaced fracture of greater tuberosity of left humerus, initial encounter for open fracture
S42.252D Displaced fracture of greater tuberosity of left humerus, subsequent encounter for fracture with routine healing
S42.252G Displaced fracture of greater tuberosity of left humerus, subsequent encounter for fracture with delayed healing
S42.252K Displaced fracture of greater tuberosity of left humerus, subsequent encounter for fracture with nonunion
S42.252P Displaced fracture of greater tuberosity of left humerus, subsequent encounter for fracture with malunion
S42.252S Displaced fracture of greater tuberosity of left humerus, sequela
S42.254A Nondisplaced fracture of greater tuberosity of right humerus, initial encounter for closed fracture
S42.254B Nondisplaced fracture of greater tuberosity of right humerus, initial encounter for open fracture
S42.254D Nondisplaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with routine healing
S42.254G Nondisplaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with delayed healing
S42.254K Nondisplaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with nonunion
S42.254P Nondisplaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with malunion
S42.254S Nondisplaced fracture of greater tuberosity of right humerus, sequela
S42.255A Nondisplaced fracture of greater tuberosity of left humerus, initial encounter for closed fracture
S42.255B Nondisplaced fracture of greater tuberosity of left humerus, initial encounter for open fracture
S42.255D Nondisplaced fracture of greater tuberosity of left humerus, subsequent encounter for fracture with routine healing
S42.255G Nondisplaced fracture of greater tuberosity of left humerus, subsequent encounter for fracture with delayed healing
S42.255K Nondisplaced fracture of greater tuberosity of left humerus, subsequent encounter for fracture with nonunion
S42.255P Nondisplaced fracture of greater tuberosity of left humerus, subsequent encounter for fracture with malunion
S42.255S Nondisplaced fracture of greater tuberosity of left humerus, sequela
S42.261A Displaced fracture of lesser tuberosity of right humerus, initial encounter for closed fracture
S42.261B Displaced fracture of lesser tuberosity of right humerus, initial encounter for open fracture
S42.261D Displaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with routine healing
S42.261G Displaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with delayed healing
S42.261K Displaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with nonunion
S42.261P Displaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with malunion
S42.261S Displaced fracture of lesser tuberosity of right humerus, sequela
S42.262A Displaced fracture of lesser tuberosity of left humerus, initial encounter for closed fracture
S42.262B Displaced fracture of lesser tuberosity of left humerus, initial encounter for open fracture
S42.262D Displaced fracture of lesser tuberosity of left humerus, subsequent encounter for fracture with routine healing
S42.262G Displaced fracture of lesser tuberosity of left humerus, subsequent encounter for fracture with delayed healing
S42.262K Displaced fracture of lesser tuberosity of left humerus, subsequent encounter for fracture with nonunion
S42.262P Displaced fracture of lesser tuberosity of left humerus, subsequent encounter for fracture with malunion
S42.262S Displaced fracture of lesser tuberosity of left humerus, sequela
S42.264A Nondisplaced fracture of lesser tuberosity of right humerus, initial encounter for closed fracture
S42.264B Nondisplaced fracture of lesser tuberosity of right humerus, initial encounter for open fracture
S42.264D Nondisplaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with routine healing
S42.264G Nondisplaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with delayed healing
S42.264K Nondisplaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with nonunion
S42.264P Nondisplaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with malunion
S42.264S Nondisplaced fracture of lesser tuberosity of right humerus, sequela
S42.265A Nondisplaced fracture of lesser tuberosity of left humerus, initial encounter for closed fracture
S42.265B Nondisplaced fracture of lesser tuberosity of left humerus, initial encounter for open fracture
S42.265D Nondisplaced fracture of lesser tuberosity of left humerus, subsequent encounter for fracture with routine healing
S42.265G Nondisplaced fracture of lesser tuberosity of left humerus, subsequent encounter for fracture with delayed healing
S42.265K Nondisplaced fracture of lesser tuberosity of left humerus, subsequent encounter for fracture with nonunion
S42.265P Nondisplaced fracture of lesser tuberosity of left humerus, subsequent encounter for fracture with malunion
S42.265S Nondisplaced fracture of lesser tuberosity of left humerus, sequela
S42.291A Other displaced fracture of upper end of right humerus, initial encounter for closed fracture
S42.291B Other displaced fracture of upper end of right humerus, initial encounter for open fracture
S42.291D Other displaced fracture of upper end of right humerus, subsequent encounter for fracture with routine healing
S42.291G Other displaced fracture of upper end of right humerus, subsequent encounter for fracture with delayed healing
S42.291K Other displaced fracture of upper end of right humerus, subsequent encounter for fracture with nonunion
S42.291P Other displaced fracture of upper end of right humerus, subsequent encounter for fracture with malunion
S42.291S Other displaced fracture of upper end of right humerus, sequela
S42.292A Other displaced fracture of upper end of left humerus, initial encounter for closed fracture
S42.292B Other displaced fracture of upper end of left humerus, initial encounter for open fracture
S42.292D Other displaced fracture of upper end of left humerus, subsequent encounter for fracture with routine healing
S42.292G Other displaced fracture of upper end of left humerus, subsequent encounter for fracture with delayed healing
S42.292K Other displaced fracture of upper end of left humerus, subsequent encounter for fracture with nonunion
S42.292P Other displaced fracture of upper end of left humerus, subsequent encounter for fracture with malunion
S42.292S Other displaced fracture of upper end of left humerus, sequela
S42.294A Other nondisplaced fracture of upper end of right humerus, initial encounter for closed fracture
S42.294B Other nondisplaced fracture of upper end of right humerus, initial encounter for open fracture
S42.294D Other nondisplaced fracture of upper end of right humerus, subsequent encounter for fracture with routine healing
S42.294G Other nondisplaced fracture of upper end of right humerus, subsequent encounter for fracture with delayed healing
S42.294K Other nondisplaced fracture of upper end of right humerus, subsequent encounter for fracture with nonunion
S42.294P Other nondisplaced fracture of upper end of right humerus, subsequent encounter for fracture with malunion
S42.294S Other nondisplaced fracture of upper end of right humerus, sequela
S42.295A Other nondisplaced fracture of upper end of left humerus, initial encounter for closed fracture
S42.295B Other nondisplaced fracture of upper end of left humerus, initial encounter for open fracture
S42.295D Other nondisplaced fracture of upper end of left humerus, subsequent encounter for fracture with routine healing
S42.295G Other nondisplaced fracture of upper end of left humerus, subsequent encounter for fracture with delayed healing
S42.295K Other nondisplaced fracture of upper end of left humerus, subsequent encounter for fracture with nonunion
S42.295P Other nondisplaced fracture of upper end of left humerus, subsequent encounter for fracture with malunion
S42.295S Other nondisplaced fracture of upper end of left humerus, sequela
Z96.611 Presence of right artificial shoulder joint
Z96.612 Presence of left artificial shoulder joint
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L39956 - Total Shoulder Arthroplasty (Future)
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
12/06/2024 01/26/2025 - N/A Future Effective You are here

Keywords

  • Total Shoulder Arthroplasty
  • TSA