M54.5

M54.5: Low back pain

Non-billable headerICD-10-CM

M54.5 is a non-billable header ICD-10-CM code for low back pain. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

intervertebral disc degeneration, lumbar region with discogenic back pain only (M51.360)
intervertebral disc degeneration, lumbosacral region with discogenic back pain only (M51.370)
low back strain (S39.012)
lumbago due to intervertebral disc displacement (M51.2-)
lumbago with sciatica (M54.4-)

Excludes1 inherited from the categories above M54.5

A category’s note binds every code beneath it.

Written on M54: Dorsalgia

psychogenic dorsalgia (F45.41)

Other codes that can never be billed with M54.5

Their own Excludes1 notes name this code, so the conflict is not listed above.

G55Nerve root and plexus compressions in diseases classified elsewhere
M54.8Other dorsalgia
R52Pain, unspecified

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

The condition this code belongs to

Low back pain ICD-10 codes

Code history

Unchanged in every release from FY2024 to FY2027.

Code to one of these instead M54.5

3 child codes. Green means billable.