Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesInjuries to the shoulder and upper armICD-10-CM s49-other-and-unspecified-shoulder-injuries
    Ask Trek AI about this page

    ICD-10-CM Code For Other And Unspecified Injuries Of Shoulder And Upper Arm: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group S49 includes other and unspecified traumatic injuries of the shoulder and upper arm, covering conditions such as unspecified sprains, strains, contusions, and soft tissue injuries of the shoulder girdle and proximal humerus. These ICD-10-CM diagnosis codes are used to document acute traumatic events affecting shoulder and upper arm structures, capturing injury location, laterality, and encounter type for treatment and follow-up. Accurate coding within the ICD-10-CM S49 group supports proper claim adjudication and complete clinical documentation for appropriate reimbursement.

    Customize your policy alerts

    Sign up for ICD-10-CM Code For Other And Unspecified Injuries Of Shoulder And Upper Arm: Group Overview policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    ICD-10-CM S49: Other And Unspecified Injuries Of Shoulder And Upper Arm Overview

    This group includes diagnoses for other and unspecified traumatic injuries to the shoulder and upper arm, involving soft tissue, joint, or bone structures. It targets the musculoskeletal system of the shoulder girdle and proximal humerus where the injury cannot be classified into more specific categories. Accurate coding matters because precise documentation supports correct claim processing and reflects clinical complexity for reimbursement.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    When to Use

    Use a code from this group when a patient presents with an acute or ongoing shoulder or upper arm injury that does not meet criteria for a more specific ICD-10-CM code group. Select codes that reflect the documented site, laterality, injury type, and whether the encounter is initial, subsequent, or for sequela.

    ICD-10-CM Codes

    234 rows

    ICD-10-CM CodeDescription
    S49.001AUnspecified physeal fracture of upper end of humerus, right arm, initial encounter for closed fracture
    S49.001DUnspecified physeal fracture of upper end of humerus, right arm, subsequent encounter for fracture with routine healing
    S49.001GUnspecified physeal fracture of upper end of humerus, right arm, subsequent encounter for fracture with delayed healing
    S49.001KUnspecified physeal fracture of upper end of humerus, right arm, subsequent encounter for fracture with nonunion
    S49.001PUnspecified physeal fracture of upper end of humerus, right arm, subsequent encounter for fracture with malunion
    S49.001SUnspecified physeal fracture of upper end of humerus, right arm, sequela
    S49.002AUnspecified physeal fracture of upper end of humerus, left arm, initial encounter for closed fracture
    S49.002DUnspecified physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with routine healing
    S49.002GUnspecified physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with delayed healing
    S49.002KUnspecified physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with nonunion
    S49.002PUnspecified physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with malunion
    S49.002SUnspecified physeal fracture of upper end of humerus, left arm, sequela
    S49.009AUnspecified physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture
    S49.009DUnspecified physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with routine healing
    S49.009GUnspecified physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with delayed healing
    S49.009KUnspecified physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with nonunion
    S49.009PUnspecified physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with malunion
    S49.009SUnspecified physeal fracture of upper end of humerus, unspecified arm, sequela
    S49.011ASalter-Harris Type I physeal fracture of upper end of humerus, right arm, initial encounter for closed fracture
    S49.011DSalter-Harris Type I physeal fracture of upper end of humerus, right arm, subsequent encounter for fracture with routine healing

    Showing 1–20 of 234

    • More pages

    DRG Codes

    15 rows

    DRG CodeDescription
    559Aftercare, Musculoskeletal System and Connective Tissue with MCC
    560Aftercare, Musculoskeletal System and Connective Tissue with CC
    561Aftercare, Musculoskeletal System and Connective Tissue without CC/MCC
    562Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh with MCC
    563Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh without MCC
    564Other Musculoskeletal System and Connective Tissue Diagnoses with MCC
    565Other Musculoskeletal System and Connective Tissue Diagnoses with CC
    566Other Musculoskeletal System and Connective Tissue Diagnoses without CC/MCC
    913Traumatic Injury with MCC
    914Traumatic Injury without MCC
    949Aftercare with CC/MCC
    950Aftercare without CC/MCC
    963Other Multiple Significant Trauma with MCC
    964Other Multiple Significant Trauma with CC
    965Other Multiple Significant Trauma without CC/MCC

    Typical Clinical Scenarios

    • A young adult presents to the emergency department after a fall off a bicycle onto the outstretched arm with immediate severe shoulder and upper arm pain, visible deformity, and limited range of motion. Imaging rules out major fractures but shows a traumatic contusion and unspecified soft tissue injury of the shoulder/upper arm requiring acute evaluation, immobilization, and short-term analgesia; an initial encounter code from this group is assigned for the acute traumatic injury. Typical codes: S49.011A, S49.021A
    • An older patient with progressive shoulder pain months after a minor twisting injury now reports persistent aching, weakness, and intermittent swelling without recent trauma; conservative management including physical therapy and corticosteroid injections is ongoing. Because the problem is a non-acute, follow-up encounter for an unspecified injury-related condition of the shoulder/upper arm, a subsequent or sequela code from this group is used to document continued care. Typical codes: S49.011D, S49.021D
    • A middle-aged worker presents for evaluation of chronic shoulder dysfunction after a prior work-related injury complicated by delayed healing and reduced range of motion; the visit documents long-term residual problems and need for work restriction notes and possible surgical consult. A code indicating a sequela or complications of the previous shoulder/upper arm injury is assigned to capture the ongoing adverse effects from the earlier trauma. Typical codes: S49.011S, S49.021S

    Related Codes

    S40-SUPERFICIAL-INJURY-OF-SHOULDER-AND-UPPER-ARM

    ICD-10-CM Code For Superficial Injury Of Shoulder And Upper Arm: Group Overview

    S41-OPEN-WOUND-OF-SHOULDER-AND-UPPER-ARM

    ICD-10-CM Code For Open Wound Of Shoulder And Upper Arm: Group Overview

    S42-FRACTURE-OF-SHOULDER-AND-UPPER-ARM

    ICD-10-CM Code For Fracture Of Shoulder And Upper Arm: Group Overview

    S43-DISLOCATION-AND-SPRAIN-SHOULDER-GIRDLE

    ICD-10-CM Code For Dislocation And Sprain Of Joints And Ligaments Of Shoulder Girdle: Group Overview

    S44-INJURY-OF-NERVES-SHOULDER-UPPER-ARM

    ICD-10-CM Code For Injury Of Nerves At Shoulder And Upper Arm Level: Group Overview

    S45-INJURY-OF-BLOOD-VESSELS-SHOULDER-UPPER-ARM

    ICD-10-CM Code For Injury Of Blood Vessels At Shoulder And Upper Arm Level: Group Overview

    S46-INJURY-OF-MUSCLE-FASCIA-AND-TENDON

    ICD-10-CM Code For Injury Of Muscle Fascia And Tendon At Shoulder And Upper Arm Level: Group Overview

    S47-CRUSHING-INJURY-OF-SHOULDER

    ICD-10-CM Code For Crushing Injury Of Shoulder And Upper Arm: Group Overview

    S48-TRAUMATIC-AMPUTATION-SHOULDER-UPPER-ARM

    ICD-10-CM Code For Traumatic Amputation Of Shoulder And Upper Arm: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.