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

ICD-10 M54.51

Billable / Specific

Vertebrogenic low back pain

M54
Block
1
Synonyms
472
LCDs
24
Payer Policies
2
Linked CPTs

About ICD-10-CM M54.51

ICD-10-CM code M54.51 represents Vertebrogenic low back pain. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M54). The 2026 edition of ICD-10-CM M54.51 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under M54.51. Per CMS ICD-10-CM Tabular 2026.

  • Low back vertebral endplate pain

Medicare LCD Coverage for M54.51

Local Coverage Determinations (LCDs) from CMS MACs that list M54.51 as a covered diagnosis.

472 LCDs

Showing top 10 of 472 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Chiropractic Services
Article ID: 56273, Effective: 2025-08-28 00:00:00, 315 covered, 0 non-covered
CPT 98942 →
CMS LCD: Billing and Coding: Chiropractic Services
Article ID: 56273, Effective: 2025-08-28 00:00:00, 315 covered, 0 non-covered
CPT 98940 →
CMS LCD: Billing and Coding: Chiropractic Services
Article ID: 56273, Effective: 2025-08-28 00:00:00, 315 covered, 0 non-covered
CPT 98941 →
CMS LCD: Billing and Coding: Chiropractic Services
Article ID: 56273, Effective: 2025-08-28 00:00:00, 315 covered, 0 non-covered
CPT 98943 →
CMS LCD: Billing and Coding: Urine Drug Testing
Article ID: 59416, Effective: 2025-11-01 00:00:00, 428 covered, 0 non-covered
CPT G0480 →
CMS LCD: Billing and Coding: Urine Drug Testing
Article ID: 59416, Effective: 2025-11-01 00:00:00, 428 covered, 0 non-covered
CPT G0481 →
CMS LCD: Billing and Coding: Urine Drug Testing
Article ID: 59416, Effective: 2025-11-01 00:00:00, 428 covered, 0 non-covered
CPT G0482 →
CMS LCD: Billing and Coding: Urine Drug Testing
Article ID: 59416, Effective: 2025-11-01 00:00:00, 428 covered, 0 non-covered
CPT G0483 →
CMS LCD: Billing and Coding: Urine Drug Testing
Article ID: 59416, Effective: 2025-11-01 00:00:00, 428 covered, 0 non-covered
CPT 80305 →
CMS LCD: Billing and Coding: Urine Drug Testing
Article ID: 59416, Effective: 2025-11-01 00:00:00, 428 covered, 0 non-covered
CPT G0659 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M54.51.

24 policies

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

5 Medicare

Billing and Coding: Bariatric Surgery Coverage
Policy ID: ART-53026
Billing and Coding: Home Health Occupational Therapy
Policy ID: ART-53057
Billing and Coding: Home Health Physical Therapy
Policy ID: ART-53058
Billing and Coding: Outpatient Occupational Therapy
Policy ID: ART-53064
Billing and Coding: Outpatient Physical Therapy
Policy ID: ART-53065

CPT Codes Commonly Billed with M54.51

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

2 linkages
  • 64629 CMS LCD: Billing and Coding: Intraosseous Basivertebral Nerve Ablation CMS LCD
  • 64628 CMS LCD: Billing and Coding: Intraosseous Basivertebral Nerve Ablation CMS LCD

ICD-10 M54.51, Billing FAQ

Is ICD-10 code M54.51 billable? +

Yes, M54.51 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to M54.51? +

ICD-10 M54.51 includes: Low back vertebral endplate pain.

What CPT codes are commonly billed with M54.51? +

Procedures frequently paired with M54.51 include: 64629, 64628.

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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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