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ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 M54.30

Billable / Specific

Sciatica, unspecified side

M54
Block
0
Synonyms
33
LCDs
11
Payer Policies
3
Linked CPTs

About ICD-10-CM M54.30

ICD-10-CM code M54.30 represents Sciatica, unspecified side. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M54). The 2026 edition of ICD-10-CM M54.30 became effective on October 1, 2025.

Medicare LCD Coverage for M54.30

Local Coverage Determinations (LCDs) from CMS MACs that list M54.30 as a covered diagnosis.

33 LCDs

Showing top 10 of 33 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
Article ID: 56607, Effective: 2025-10-01 00:00:00, 604 covered, 0 non-covered
CPT 64416 →
CMS LCD: Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
Article ID: 56607, Effective: 2025-10-01 00:00:00, 604 covered, 0 non-covered
CPT 64446 →
CMS LCD: Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
Article ID: 56607, Effective: 2025-10-01 00:00:00, 604 covered, 0 non-covered
CPT 64448 →
CMS LCD: Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
Article ID: 56607, Effective: 2025-10-01 00:00:00, 604 covered, 0 non-covered
CPT 64449 →
CMS LCD: Billing and Coding: Implantable Infusion Pump
Article ID: 56695, Effective: 2025-10-01 00:00:00, 2017 covered, 0 non-covered
CPT 62326 →
CMS LCD: Billing and Coding: Implantable Infusion Pump
Article ID: 56695, Effective: 2025-10-01 00:00:00, 2017 covered, 0 non-covered
CPT E0782 →
CMS LCD: Billing and Coding: Implantable Infusion Pump
Article ID: 56695, Effective: 2025-10-01 00:00:00, 2017 covered, 0 non-covered
CPT 62367 →
CMS LCD: Billing and Coding: Implantable Infusion Pump
Article ID: 56695, Effective: 2025-10-01 00:00:00, 2017 covered, 0 non-covered
CPT J9200 →
CMS LCD: Billing and Coding: Implantable Infusion Pump
Article ID: 56695, Effective: 2025-10-01 00:00:00, 2017 covered, 0 non-covered
CPT 62322 →
CMS LCD: Billing and Coding: Implantable Infusion Pump
Article ID: 56695, Effective: 2025-10-01 00:00:00, 2017 covered, 0 non-covered
CPT 62323 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M54.30.

11 policies

5 Aetna

Peripheral Electrical Nerve Stimulation for Pain - Medical Clinical Policy Bulletins | Aetna
Policy ID: CPB-0011
Back Pain - Invasive Procedures - Medical Clinical Policy Bulletins | Aetna
Policy ID: CPB-0016
Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) of the Spine
Policy ID: CPB-0236
Transforaminal Epidural Injections
Policy ID: CPB-0722
Discography
Policy ID: CPB-0733

4 Cigna

Acupuncture - (CPG024)
Policy ID: CPG024_ACUPUNCTURE
Electrodiagnostic Testing (EMG/NCV) - (CPG129)
Policy ID: CPG129_EMG_NCV_SSEP
Intraoperative Monitoring - (0509)
Policy ID: MM_0509
Peripheral Nerve Destruction for Pain Conditions - (0525) ---- future effective policy
Policy ID: MM_0525

2 Medicare

Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
Policy ID: ART-56607
Billing and Coding: Implantable Infusion Pump
Policy ID: ART-56695

CPT Codes Commonly Billed with M54.30

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

3 linkages
  • 64483 Transforaminal epidural injection lumbar — low back pain, lumbosacral radiculopathy, lumbar disc herniation, nerve root compression, spinal stenosis, spondylosis Pain Management
  • 98940 CMT spinal 1-2 regions — low back pain, cervicalgia, somatic dysfunction cervical/thoracic/lumbar/sacral, cervical radiculopathy, lumbosacral neuritis Chiropractic
  • 98941 CMT spinal 3-4 regions — same as 98940, multiple regions Chiropractic

Convert M54.30 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
M54.30 7243 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 M54.30, Billing FAQ

Is ICD-10 code M54.30 billable? +

Yes, M54.30 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What CPT codes are commonly billed with M54.30? +

Procedures frequently paired with M54.30 include: 64483, 98940, 98941.

What ICD-9 codes does M54.30 map to? +

Per CMS GEMs, M54.30 maps to ICD-9 codes: 7243. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on July 17, 2026.

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