M47.816: Spondylosis without myelopathy or radiculopathy, lumbar region

The ICD-10-CM code for lumbar spondylosis when degenerative changes of the lumbar spine are documented without myelopathy or radiculopathy.

Billable

FY2027

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At a glance

Code Family

M47.81: Spondylosis without myelopathy or radiculopathy.

DRG Grouping

Inpatient admissions with M47.816 as a principal musculoskeletal diagnosis group to the medical back problem MS-DRGs in MDC 8 under the FY2027 MS-DRG v44 grouper, MS-DRG 551 with MCC or MS-DRG 552 without MCC.

HCC Mapping (v28)

None. M47.816 maps to no CMS-HCC v28 category and mapped to none in v24.

Condition

Lumbar spondylosis

Family Specificity

Spinal region. The M47.81 subcategory runs from the occipito-atlanto-axial region through the sacral and sacrococcygeal region, plus a site unspecified code. M47.816 is the lumbar-region code.

Billable

Yes. Valid in the FY2026 code set and unchanged in the FY2027 update.

Which spondylosis code do I assign?

M47.81 is specified by anatomical site. The code follows the spinal region the provider documents. Before choosing within this subcategory, confirm that neither myelopathy nor radiculopathy is documented. A neurological complication moves the encounter to a different M47 subcategory entirely.

When documentation says…

Code

Degenerative changes of the lumbar spine, no radiculopathy or myelopathy

M47.816

Use when documentation identifies the lumbar region and describes lumbar spondylosis or lumbar osteoarthritis of the spine with no neurological involvement.

Spondylosis of the lumbosacral region

M47.817

Use when documentation places the degenerative changes at the lumbosacral region rather than the lumbar region alone.

Spondylosis of the thoracolumbar region

M47.815

Use when the documented site is the thoracolumbar junction.

Spondylosis of the thoracic region

M47.814

Use when the documented site is the thoracic spine.

Spondylosis of the cervicothoracic region

M47.813

Use when the documented site is the cervicothoracic junction.

Spondylosis of the cervical region

M47.812

Use when the documented site is the cervical spine.

Spondylosis of the occipito-atlanto-axial region

M47.811

Use when the documented site is the occipito-atlanto-axial region.

Spondylosis without myelopathy or radiculopathy, region not stated

M47.819

Use only when the record does not identify a spinal region. Assigning M47.819 when documentation clearly indicates the lumbar spine is a site specificity error. M47.816 applies whenever the lumbar region is documented.

Tabular notes

EXCLUDES1

No Excludes1 or Excludes2 note sits at M47.816, M47.81, M47.8 or category M47. The only note at category M47 is an Includes note for arthrosis or osteoarthritis of spine and for degeneration of facet joints. Subcategory M54.1 carries an Excludes1 note for radiculopathy with spondylosis (the M47.2 codes). The separation from spondylosis with radiculopathy is written into the descriptor. When radiculopathy is documented with the lumbar spondylosis, M47.26 applies and M47.816 is not reported for the same site.

USE ADDITIONAL, CODE ALSO AND CODE FIRST

M47.816 carries no Code first, Use additional or Code also note at any level. Chapter 13 carries a general note to use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause.

DEFINITIVE DIAGNOSIS OVER SYMPTOM CODE

When a structural lumbar spondylosis diagnosis is established, M47.816 is preferred over the symptom code M54.50 (Low back pain, unspecified). Guideline I.B.5 states that signs and symptoms associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

FY2027: EFFECTIVE 1 OCTOBER 2026

None. The FY2027 codes addenda add, delete or revise no code in category M47. The FY2027 tabular addenda change no note at M47, M47.8 or M47.81. M47.816 is unchanged in the FY2027 update.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

No HCC mapping applies. M47.816 does not map to any HCC category in CMS-HCC v28 and did not map to any category in v24.

Lumbar spondylosis without neurological complication does not affect Medicare Advantage risk scores.

MS-DRG ASSIGNMENT: FY2027 (V44)

Inpatient admissions with M47.816 as a principal musculoskeletal diagnosis group to the medical back problem MS-DRGs under MDC 8. The pair uses a two-tier structure: MS-DRG 551 for medical back problems with MCC and MS-DRG 552 without MCC.

Inpatient, M47.816 can be reported as a secondary diagnosis. When the admission is for a surgical procedure addressing the spondylosis, such as a laminectomy or fusion, the procedure drives DRG assignment and M47.816 supports the indication.

MEDICARE

M47.816 supports medical necessity for lumbar imaging, physical therapy, and interventional pain management.

Documentation checklist to support M47.816

Chart elements that support code selection and reduce specificity-driven denials.

A documented diagnosis of lumbar spondylosis or lumbar osteoarthritis of the spine. Either clinical term supports M47.816 when radiculopathy and myelopathy are absent.

The spinal region documented as lumbar. The record supports M47.816 rather than the site-unspecified code M47.819.

Absence of radiculopathy, with no description of radiating pain in a dermatomal pattern or nerve root involvement. If those findings are present, M47.2- applies.

Absence of myelopathy, with no documented signs of spinal cord compression such as upper motor neuron findings or gait disturbance from cord involvement.

Provider clarification sought when the record documents back pain that may arise from a cause distinct from the spondylosis.

FAQ

Can M47.816 and M54.50 be coded together?

M47.816 and M54.50 are not coded together for the same complaint. When the back pain is attributed to the spondylosis, M47.816 is reported and M54.50 is not. Guideline I.B.5 states that signs and symptoms associated routinely with a disease process should not be assigned as additional codes. If the provider documents back pain from a distinct cause separate from the spondylosis, additional coding may be appropriate. Seek provider clarification when it is unclear.

What happens when radiculopathy is documented alongside lumbar spondylosis?

The presence of radiculopathy moves the encounter to the M47.2- subcategory, where the lumbar-region code is M47.26. M47.816 and M47.26 are not co-coded for the same site.

Does M47.816 add risk adjustment weight?

No. M47.816 carries no HCC mapping in CMS-HCC v28 or v24. It makes no contribution to a Medicare Advantage risk score.

Which MS-DRGs does M47.816 group to on the inpatient side?

As a principal musculoskeletal diagnosis it groups to the MDC 8 medical back problem DRGs under the FY2027 MS-DRG v44 grouper, MS-DRG 551 with MCC or MS-DRG 552 without MCC. When a spinal procedure is performed, the procedure drives the DRG instead.

Related codes

Codes in the same family as M47.816. Only codes with a published page render as links.

Sibling codes in the M47.81 family

M47.811: Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region.
M47.812: Spondylosis without myelopathy or radiculopathy, cervical region.
M47.813: Spondylosis without myelopathy or radiculopathy, cervicothoracic region.
M47.814: Spondylosis without myelopathy or radiculopathy, thoracic region.
M47.815: Spondylosis without myelopathy or radiculopathy, thoracolumbar region.
M47.816: Spondylosis without myelopathy or radiculopathy, lumbar region.
M47.817: Spondylosis without myelopathy or radiculopathy, lumbosacral region.
M47.818: Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region.
M47.819: Spondylosis without myelopathy or radiculopathy, site unspecified.

Additional codes to consider

Codes outside the M47.81 family considered alongside M47.816.

Consider instead

M47.26: Other spondylosis with radiculopathy, lumbar region, when radiculopathy is documented.
M54.50: Low back pain, unspecified, when no structural spondylosis diagnosis has been established.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software