M54.5 — Low back pain
Is M54.5 billable?
No — M54.5 is a non-billable header code. M54.5 groups more specific codes and cannot be submitted on a claim. A valid ICD-10-CM code must be reported at the highest level of specificity available in its branch. Select one of the 3 billable codes beneath M54.5.
Billable codes under this header
M54.5 at a glance
| Code | M54.5 |
|---|---|
| Description | Low back pain |
| Billable | No — header code |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
Excludes1 — never code together
The conditions below can never be reported together with M54.5 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
Excludes1 — never code together — inherited from M50-M54
The conditions below can never be reported together with M54.5 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- current injury - see injury of spine by body region
- discitis NOS (M46.4-)
Excludes1 — never code together — inherited from M54
The conditions below can never be reported together with M54.5 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- psychogenic dorsalgia (F45.41)
Excludes2 — not included here — inherited from Chapter 13
The conditions below are not part of M54.5, but a patient may have both at the same time. When documentation supports it, M54.5 and the excluded code may both be reported.
- arthropathic psoriasis (L40.5-)
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- compartment syndrome (traumatic) (T79.A-)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
What codes fall under M54.5? (3)
How long has M54.5 existed?
M54.5 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
- FY2022: M54.5 stopped being billable
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.