Is G54.4 a billable ICD-10-CM code?

Yes. G54.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does G54.4 sit in the tabular list?

Diseases of the nervous system (G00-G99), in the block Nerve, nerve root and plexus disorders (G50-G59).

What cannot be coded together with G54.4?

G54.4 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above G54.4 (G54) and apply to it just the same.

G54.4

G54.4 — Lumbosacral root disorders, not elsewhere classified

Billable / specific codeICD-10-CM

G54.4 is a billable, specific ICD-10-CM code for lumbosacral root disorders, not elsewhere classified. It is valid for submission on a claim.

Excludes1 inherited from the categories above G54.4

These are not written on G54.4, but they bind it: a note on a category applies to every code beneath it. Billing G54.4 with anything listed here is a denial.

Written on G54 — Nerve root and plexus disorders

current traumatic nerve root and plexus disorders - see nerve injury by body region
intervertebral disc disorders (M50-M51)
neuralgia or neuritis NOS (M79.2)
neuritis or radiculitis brachial NOS (M54.13)
neuritis or radiculitis lumbar NOS (M54.16)
neuritis or radiculitis lumbosacral NOS (M54.17)
neuritis or radiculitis thoracic NOS (M54.14)
radiculitis NOS (M54.10)
radiculopathy NOS (M54.10)
spondylosis (M47.-)

Risk adjustment

G54.4 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

G54.4 is named in 22 Medicare coverage policies — 22 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A53057Billing and Coding: Home Health Occupational Therapy
A53058Billing and Coding: Home Health Physical Therapy
A53064Billing and Coding: Outpatient Occupational Therapy
A53065Billing and Coding: Outpatient Physical Therapy

How G54.4 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to G54.4.

Disorder›lumbosacral›root NEC(nerve)
Lesion›lumbosacral›root NEC(nerve)

Code history

G54.4 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share G54. If G54.4 is not quite right, the correct code is usually one of these.

Questions about G54.4

Is G54.4 a billable ICD-10-CM code?: Yes. G54.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does G54.4 sit in the tabular list?: Diseases of the nervous system (G00-G99), in the block Nerve, nerve root and plexus disorders (G50-G59).
What cannot be coded together with G54.4?: G54.4 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above G54.4 (G54) and apply to it just the same.