CPT 27279: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 27279 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 27279 with a diagnosis that isn't covered typically denies as CARC 50 — not medically necessary.
National approximation. Coverage varies by MAC and state — confirm against the specific LCD/NCD and article that applies to your jurisdiction and date of service.
| ICD-10 | Description |
|---|---|
| M43.17 | Spondylolisthesis, lumbosacral region |
| M43.18 | Spondylolisthesis, sacral and sacrococcygeal region |
| M43.27 | Fusion of spine, lumbosacral region |
| M43.28 | Fusion of spine, sacral and sacrococcygeal region |
| M46.1 | Sacroiliitis, not elsewhere classified |
| M51.17 | Intervertebral disc disorders with radiculopathy, lumbosacral region |
| M53.2X7 | Spinal instabilities, lumbosacral region |
| M53.2X8 | Spinal instabilities, sacral and sacrococcygeal region |
| M53.3 | Sacrococcygeal disorders, not elsewhere classified |
| M53.87 | Other specified dorsopathies, lumbosacral region |
| M53.88 | Other specified dorsopathies, sacral and sacrococcygeal region |
| M54.18 | Radiculopathy, sacral and sacrococcygeal region |
| M99.04 | Segmental and somatic dysfunction of sacral region |
| M99.14 | Subluxation complex (vertebral) of sacral region |
| Q74.2 | Other congenital malformations of lower limb(s), including pelvic girdle |
| S33.2XXA | Dislocation of sacroiliac and sacrococcygeal joint, initial encounter |
| S33.2XXD | Dislocation of sacroiliac and sacrococcygeal joint, subsequent encounter |
| S33.2XXS | Dislocation of sacroiliac and sacrococcygeal joint, sequela |
| S33.6XXA | Sprain of sacroiliac joint, initial encounter |
| S33.6XXD | Sprain of sacroiliac joint, subsequent encounter |
| S33.6XXS | Sprain of sacroiliac joint, sequela |
| S33.8XXA | Sprain of other parts of lumbar spine and pelvis, initial encounter |
| S33.8XXD | Sprain of other parts of lumbar spine and pelvis, subsequent encounter |
| S33.8XXS | Sprain of other parts of lumbar spine and pelvis, sequela |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 27279?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 24 ICD-10 diagnosis codes that support medical necessity for CPT 27279. The covered codes are listed on this page. Coverage varies by MAC/state — always confirm against the policy that applies to you.
What is a medical-necessity (LCD/NCD) crosswalk?
A claim whose procedure isn't supported by a covered diagnosis denies as "not medically necessary" (CARC 50). CMS coverage policies define which diagnoses justify a procedure; this page is the ICD-10 → CPT 27279 view of that relationship.
More free billing tools: all crosswalks · NCCI edits · Medicare fees · denial codes
Informational only, not coding, billing, or legal advice. Based on CMS Medicare Coverage Database data; verify the current LCD/NCD for your MAC before billing.
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