M54.42
M54.42 — Lumbago with sciatica, left side
Billable / specific codeICD-10-CMleft
M54.42 is a billable, specific ICD-10-CM code for lumbago with sciatica, left side. It is valid for submission on a claim.
Risk adjustment
M54.42 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
M54.42 is named in 26 Medicare coverage policies — 20 listing it as supporting medical necessity, and 6 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
Related codes at this level
Codes that share M54.4. If M54.42 is not quite right, the correct code is usually one of these.
Questions about M54.42
- Is M54.42 a billable ICD-10-CM code?
- Yes. M54.42 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M54.42 sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Other dorsopathies (M50-M54).