M54.51 — Vertebrogenic low back pain
M54.51 is a billable, specific ICD-10-CM code for vertebrogenic low back pain. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Low back vertebral endplate pain
Risk adjustment
M54.51 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
M54.51 is named in 34 Medicare coverage policies — 22 listing it as supporting medical necessity, and 12 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A57497Billing and Coding: Chest X-Ray Policynot covered
- A57701Billing and Coding: Trigger Point Injections (TPI)not covered
- 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
How M54.51 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 M54.51.
- Pain›low back›vertebral end plate
- Pain›low back›vertebrogenic
- Pain›lumbar region›vertebral end plate
- Pain›lumbar region›vertebrogenic
- Pain›vertebrogenic›low back
- Pain›vertebrogenic›lumbar
Related codes at this level
Codes that share M54.5. If M54.51 is not quite right, the correct code is usually one of these.
Questions about M54.51
- Is M54.51 a billable ICD-10-CM code?
- Yes. M54.51 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M54.51 sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Other dorsopathies (M50-M54).