ICD-10 Rotator Cuff Tear Codes 2026: The Complete Orthopaedic Coding Reference

For 2026, rotator cuff tears are coded in ICD-10-CM using two distinct families depending on whether the tear is traumatic or nontraumatic. Traumatic rotator cuff tears fall under the S46.01- series (injury of muscle and tendon of the rotator cuff of shoulder), while chronic, degenerative, or nontraumatic complete tears are reported with M75.1- (rotator cuff tear or rupture, not specified as traumatic). Choosing correctly between these two families, and then capturing laterality and the right seventh character or specificity, is where orthopaedic practices most often lose reimbursement or trigger denials on shoulder claims.

This reference breaks down the key rotator cuff codes for 2026, explains the traumatic-versus-nontraumatic decision that drives correct coding, and highlights the documentation that protects your claims. Always verify final code selection against the current ICD-10-CM official guidelines, because the distinction between an acute injury and a chronic degenerative condition is a clinical determination that must be supported in the note.

Traumatic vs. Nontraumatic: The Decision That Drives the Code

The single most important coding decision for a rotator cuff tear is whether it is traumatic or nontraumatic, because it sends you into completely different ICD-10 chapters. A traumatic tear results from a specific acute injury event, such as a fall or a forceful movement, and is coded from the S46.01- injury series in Chapter 19, which also requires a seventh character for the encounter type and an associated external cause code where appropriate. A nontraumatic tear is degenerative or chronic in nature and is coded from the M75.1- series in the musculoskeletal chapter.

The clinical documentation must clearly support which scenario applies. A note that simply says “rotator cuff tear” without indicating mechanism, chronicity, or whether a specific injury occurred forces the coder to query the provider or risk an inaccurate code. Because traumatic and nontraumatic tears can carry different reimbursement and medical-necessity implications, this is a high-value place to tighten documentation.

Key ICD-10 Rotator Cuff Tear Codes for 2026

For nontraumatic tears, the M75.1- family is the workhorse. It distinguishes incomplete from complete rotator cuff tears not specified as traumatic and requires laterality. Practices should code to the highest level of specificity available, capturing whether the tear is complete or incomplete and identifying the right or left shoulder rather than defaulting to an unspecified code. Unspecified laterality codes are a common, avoidable denial trigger.

For traumatic tears, the S46.01- series captures injury of the muscle and tendon of the rotator cuff. These codes require laterality and a seventh character indicating whether the encounter is initial, subsequent, or for sequela. Omitting the seventh character renders the code invalid and the claim will reject. When the tear is traumatic, an appropriate external cause code can add supporting detail about how the injury occurred.

Across both families, the recurring theme is specificity: correct family, correct laterality, and, for traumatic codes, the correct seventh character. The AMA and CMS both emphasize coding to the highest level of detail supported by the documentation, and rotator cuff claims are an area where that detail directly affects whether a claim is paid.

Pairing Rotator Cuff Diagnoses With the Right CPT Codes

Diagnosis coding does not happen in isolation. A rotator cuff tear diagnosis frequently accompanies arthroscopic repair, debridement, or related shoulder procedures, and the ICD-10 code must support the medical necessity of whatever CPT procedure is billed. When the diagnosis is vague or the laterality is missing, even a correctly coded procedure can be denied for lack of supporting medical necessity. Aligning the specific rotator cuff diagnosis with the surgical CPT code, and ensuring the operative note documents the findings that justify the procedure, is essential to clean claims.

Documentation Best Practices for Rotator Cuff Claims

Strong documentation answers four questions before the coder ever opens the chart: Is the tear traumatic or nontraumatic? Is it complete or incomplete? Which shoulder? And, if traumatic, what was the mechanism and is this the initial or a subsequent encounter? When the operative and clinical notes capture those elements explicitly, coding becomes straightforward and denials drop. When they do not, coders are forced to query providers, which slows the revenue cycle and invites errors. Documentation templates that prompt for laterality, chronicity, and mechanism at the point of care are one of the highest-leverage ways to protect shoulder revenue.

Frequently Asked Questions

What is the ICD-10 code for a nontraumatic rotator cuff tear?

Nontraumatic, chronic, or degenerative rotator cuff tears are coded from the M75.1- series (rotator cuff tear or rupture, not specified as traumatic), with codes distinguishing incomplete from complete tears and requiring right or left laterality.

What is the ICD-10 code for a traumatic rotator cuff tear?

Traumatic rotator cuff tears are coded from the S46.01- series for injury of the muscle and tendon of the rotator cuff of the shoulder, which requires laterality and a seventh character for the encounter type (initial, subsequent, or sequela).

How do I decide between a traumatic and nontraumatic rotator cuff code?

It depends on the clinical documentation. If a specific acute injury event caused the tear, it is traumatic and coded from the S46.01- series. If the tear is degenerative or chronic without an acute injury, it is nontraumatic and coded from M75.1-.

Why do rotator cuff claims get denied?

The most common reasons are unspecified laterality, choosing the wrong traumatic-versus-nontraumatic family, missing the required seventh character on traumatic codes, and documentation that does not support the medical necessity of the billed procedure.

Do rotator cuff codes require laterality in 2026?

Yes. Both the M75.1- and S46.01- families require right or left shoulder specificity. Defaulting to unspecified laterality when the side is documented is a frequent and avoidable cause of denials.

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