ICD-10 M54.5
Non-Billable HeaderLow back pain
About ICD-10-CM M54.5
ICD-10-CM code M54.5 represents Low back pain. This is a non-billable header code in the Musculoskeletal and Connective Tissue chapter (block M54). The 2026 edition of ICD-10-CM M54.5 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Coding Tips for M54.5
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
M54.5 was deleted October 2021. Use M54.50 (low back pain unspecified), M54.51 (vertebrogenic), M54.59 (other) instead.
Type 1 Excludes
Pure excludes, these codes can never be coded together with M54.5. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- 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-)
Medicare LCD Coverage for M54.5
Local Coverage Determinations (LCDs) from CMS MACs that list M54.5 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing M54.5.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but M54.5 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with M54.5
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 64483 Transforaminal epidural — low back pain, sciatica, disc herniation Pain Medicine
- 64493 Facet injection — back pain, spondylosis Pain Medicine
- 64635 Facet neurolysis — chronic back pain Pain Medicine
- 72148 MRI lumbar spine without contrast — low back pain, lumbago, lumbar radiculopathy, lumbar disc herniation, spinal stenosis, lumbar sprain, spondylosis Radiology
Convert M54.5 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| M54.5 | 7242 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To M54.5
Other codes in section M50-M54 (Other dorsopathies).
ICD-10 M54.5, Billing FAQ
Is ICD-10 code M54.5 billable? +
No, M54.5 is a non-billable header code. Use a more specific child code from block M54 when submitting claims.
What codes are Type 1 Excludes for M54.5? +
Type 1 Excludes (never code together with M54.5): 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)
What CPT codes are commonly billed with M54.5? +
Procedures frequently paired with M54.5 include: 64483, 64493, 64635, 72148.
What ICD-9 codes does M54.5 map to? +
Per CMS GEMs, M54.5 maps to ICD-9 codes: 7242. 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 May 31, 2026.
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