M54.50 — Low back pain, unspecified
Is M54.50 billable?
Yes, but M54.50 is an unspecified code. M54.50 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, M54.50 is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting M54.50 — the more specific alternatives are listed below.
More specific alternatives
M54.50 at a glance
| Code | M54.50 |
|---|---|
| Description | Low back pain, unspecified |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
Which MS-DRGs does M54.50 group to?
M54.50 sits in MDC 08 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 551Medical Back Problems with MCCmedical
- 552Medical Back Problems without MCCmedical
How is M54.50 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to M54.50. They show the wording a clinician may have documented, which often differs from the Tabular description.
- Lumbago, lumbalgia
- Low › back syndrome
- Pain › loin (s)
- Pain › low back (s)
- Pain › lumbar region (s)
- Pain › spine › low back (s)
- Syndrome › low › back
Inclusion terms
Alternative wording in documentation that is classified to M54.50.
- Loin pain
- Lumbago NOS
Excludes1 — never code together — inherited from M50-M54
The conditions below can never be reported together with M54.50 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 M54.50 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)
Excludes1 — never code together — inherited from M54.5
The conditions below can never be reported together with M54.50 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
Excludes2 — not included here — inherited from Chapter 13
The conditions below are not part of M54.50, but a patient may have both at the same time. When documentation supports it, M54.50 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)
How long has M54.50 existed?
M54.50 first appears in FY2022.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.