Low back pain
Low back pain
M54.5 is a header (parent) code in the ICD-10-CM hierarchy. It is not billable for claim submission. Use one of the billable child codes listed below.
Billable codes in this category
Each of the codes below is billable. Choose the one that most accurately describes the patient's diagnosis.
Low back pain documented without a specified cause, type, or anatomical origin — the default lumbar pain code when clinical evaluation has not yet characterized the pain as vertebrogenic, mechanical, or otherwise defined.
M54.51 classifies axial low back pain arising specifically from vertebral structures — most commonly vertebral endplate pathology with associated Modic-type changes — as distinguished from muscular, discogenic, or radicular sources.
Low back pain that is clinically defined and attributable to a specific cause, but does not meet criteria for vertebrogenic low back pain (M54.51) and is not otherwise classifiable by a more specific code.
Inclusion & exclusion notes
Excludes 1 (mutually exclusive — never code together)
- 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-)