M06.042: Rheumatoid arthritis without rheumatoid factor, left hand
Rheumatoid arthritis without rheumatoid factor, left hand
Quick Clinical & Billing Summary
What is ICD-10-CM code M06.042? M06.042 represents Rheumatoid arthritis without rheumatoid factor, left hand. Under official CDC guidelines, this code is billable and specific for claim submission.
Code Hierarchy & Classification
Clinical Guidance & Documentation Standards
CMS-HCC Risk Adjustment Model
Diagnoses under category M06 map to the official CMS-HCC (Hierarchical Condition Category) risk adjustment model used for Medicare Advantage risk scoring.
Associated Procedures & Medicare RVU Reimbursement
Open RVU Calculator →Typical outpatient and office evaluation procedures frequently billed alongside diagnosis M06.042:
| CPT/HCPCS | Description | Work RVU | Non-Facility Fee | Facility Fee |
|---|---|---|---|---|
| 99213 | Office/outpatient visit, established patient, 20-29 minutes (Low MDM) | 1.30 | $91.69 | $66.79 |
| 99214 | Office/outpatient visit, established patient, 30-39 minutes (Moderate MDM) | 1.92 | $133.61 | $100.21 |
| 96372 | Therapeutic, prophylactic, or diagnostic injection (subcutaneous/intramuscular) | 0.17 | $18.34 | $12.44 |
CPT Modifier & Billing Rules
Append when a significant, separately identifiable evaluation and management service is provided on the same calendar day as a minor surgical procedure or injection.
Identifies procedures or services not normally reported together but distinct under the clinical circumstances. Use CMS X-modifiers (XE, XS, XP, XU) where required by Medicare.
Frequently Asked Questions about M06.042
Is M06.042 a billable ICD-10 code?
Yes, M06.042 is a valid, billable and specific ICD-10-CM code. It can be reported as a primary or secondary diagnosis on medical claims.
What is the ICD-10 code for Rheumatoid arthritis without rheumatoid factor, left hand?
The primary ICD-10-CM code for Rheumatoid arthritis without rheumatoid factor, left hand is M06.042.
What is the effective date of the current M06.042 code?
The code is active for fiscal year FY2027, effective starting 2026-10-01.
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