M54.81
M54.81: Occipital neuralgia
Billable / specific codeICD-10-CM
M54.81 is a billable, specific ICD-10-CM code for occipital neuralgia. It is valid for submission on a claim.
Check M54.81 with the rest of the claim: free scrubberOther codes that can never be billed with M54.81
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
M54.81 is named in 23 Medicare coverage policies: 16 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58883Billing 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
Alphabetic index entries that lead here
- Neuralgia, neuralgic›occipital
The condition this code belongs to
Code history
Unchanged in every release from FY2024 to FY2027.