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

ICD-10 M54.6

Billable / Specific

Pain in thoracic spine

M54
Block
0
Synonyms
986
LCDs
30
Payer Policies
1
Linked CPTs

About ICD-10-CM M54.6

ICD-10-CM code M54.6 represents Pain in thoracic spine. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M54). The 2026 edition of ICD-10-CM M54.6 became effective on October 1, 2025.

Type 1 Excludes

Pure excludes, these codes can never be coded together with M54.6. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • pain in thoracic spine due to intervertebral disc disorder (M51.-)

Medicare LCD Coverage for M54.6

Local Coverage Determinations (LCDs) from CMS MACs that list M54.6 as a covered diagnosis.

986 LCDs

Showing top 10 of 986 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 19300 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 15877 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 19371 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 19380 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 30468 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 30400 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 19396 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 30435 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 30465 →
CMS LCD: Billing and Coding: Cosmetic and Reconstructive Surgery
Article ID: 58573, Effective: 2025-11-17 00:00:00, 137 covered, 1 non-covered
CPT 30462 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M54.6.

30 policies

2 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

2 Cigna

Acupuncture - (CPG024)
Policy ID: CPG024_ACUPUNCTURE
Electrodiagnostic Testing (EMG/NCV) - (CPG129)
Policy ID: CPG129_EMG_NCV_SSEP

5 Medicare

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
Billing and Coding: Nerve Conduction Studies and Electromyography
Policy ID: ART-54969

CPT Codes Commonly Billed with M54.6

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

1 linkages
  • M0076 CMS LCD: Billing and Coding: Trigger Point Injections CMS LCD

Convert M54.6 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
M54.6 7241 00000

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

ICD-10 M54.6, Billing FAQ

Is ICD-10 code M54.6 billable? +

Yes, M54.6 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What codes are Type 1 Excludes for M54.6? +

Type 1 Excludes (never code together with M54.6): pain in thoracic spine due to intervertebral disc disorder (M51.-)

What CPT codes are commonly billed with M54.6? +

Procedures frequently paired with M54.6 include: M0076.

What ICD-9 codes does M54.6 map to? +

Per CMS GEMs, M54.6 maps to ICD-9 codes: 7241. Useful for legacy data review and historical claim analysis.

Get the full PayerReady toolkit

Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.

Start free →

Run this code through our claim audit tool

Check NCCI bundling, MUE limits, and modifier logic before submission.

Try the auditor →

Did this page help?

Quick signal so we know what to improve.

Thanks!

If you want a code reference page that doesn't exist yet, email coding@payerready.com.

Sorry to hear that.

Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.

Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team

Faster Approvals

Ready to Cut Your Enrollment Timeline in Half?

Join providers in all 50 states who handed off credentialing to a dedicated specialist. Create your free account in minutes and start enrolling the same day.

All 50 States Covered
No Long-Term Contracts
HIPAA HIPAA Compliant Platform
Dedicated Specialist Included