ICD-10 · PDGM grouping
M04-M04 — Autoinflammatory syndromes
Every ICD-10-CM code in this range and the PDGM clinical group CMS assigns to it, read from the CMS grouper crosswalk v07.2.26.
Codes in range
5
No clinical group
1
A period cannot be grouped from these.
Barred as primary
0
CMS rejects these in the primary position.
Where these codes group
3 of the 5 codes in M04-M04 group to Musculoskeletal Rehabilitation, but the range is not uniform — it spreads across 2 clinical groups. A further 1 are assigned no clinical group at all, which means a 30-day period cannot be grouped from them.
Code families in M04-M04
One page per three-character family: every code in it, whether it can lead a claim, its clinical group and comorbidity subgroup.
Every code in M04-M04
Descriptions are CMS’s own, abbreviated as CMS abbreviates them.
| Code | Description | Clinical group | Primary position |
|---|---|---|---|
| M041 | Periodic fever syndromes | A | Can lead a claim |
| M042 | Cryopyrin-associated periodic syndromes | E | Can lead a claim |
| M043 | VEXAS syndrome | E | Can lead a claim |
| M048 | Other autoinflammatory syndromes | E | Can lead a claim |
| M049 | Autoinflammatory syndrome, unspecified | None | Cannot lead a claim |
Source: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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