M54.9
M54.9: Dorsalgia, unspecified
Billable / specific codeICD-10-CM
M54.9 is a billable, specific ICD-10-CM code for dorsalgia, unspecified. It is valid for submission on a claim.
Check M54.9 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Backache NOS
- Back pain NOS
Other codes that can never be billed with M54.9
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
M54.9 is named in 16 Medicare coverage policies: 9 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
- Backache(postural)
- Dorsalgia
- Pain›back(postural)
- Pain›spine
The condition this code belongs to
Code history
Unchanged in every release from FY2024 to FY2027.