Back Pain ICD-10 Codes 2026M54, M51, M48 Complete Reference Guide
Comprehensive reference for all back pain ICD-10 codes. Low back pain (M54.50-M54.59), disc herniation, spinal stenosis, radiculopathy, and sciatica with documentation guidelines.
Important: M54.5 No Longer Valid
As of the 2022 CMS final rule, code M54.5 (Low back pain) was retired and replaced with three more specific codes: M54.50 (unspecified), M54.51 (vertebrogenic), and M54.59 (other). Using M54.5 will result in claim denials.
Low Back Pain Codes (M54.50-M54.59)
Low back pain is one of the most common diagnoses. Choose the appropriate code based on clinical findings and documentation.
Low back pain, unspecified
BillableUse when cause is not yet determined or doesn't fit other categories
Documentation: Document location, severity, duration, and aggravating factors
Vertebrogenic low back pain
BillablePain from vertebral endplate damage; requires imaging confirmation
Documentation: MRI/CT showing Modic changes, document "deep burning/aching" in mid-lower back
Other low back pain
BillableWhen cause is known but doesn't fit M54.50 or M54.51
Documentation: Document specific etiology (muscular, ligamentous, etc.)
M54.51 Vertebrogenic Low Back Pain - Documentation Requirements
M54.51 has the strictest documentation standards. It requires:
- 1.MRI or CT imaging showing Modic changes or vertebral endplate damage
- 2.Documentation of "deep, burning, or aching pain in the middle lower back"
- 3.Clinical correlation between imaging findings and symptoms
Back Pain Codes by Spinal Region
| Code | Description | Region | Billable |
|---|---|---|---|
| M54.2 | Cervicalgia (neck pain) | Cervical | Yes |
| M54.6 | Pain in thoracic spine | Thoracic | Yes |
| M54.50 | Low back pain, unspecified | Lumbar | Yes |
| M54.51 | Vertebrogenic low back pain | Lumbar | Yes |
| M54.59 | Other low back pain | Lumbar | Yes |
| M54.9 | Dorsalgia, unspecified | Any | Yes |
Radiculopathy Codes (M54.1x)
Radiculopathy codes indicate nerve root compression with radiating pain, numbness, or weakness. Distinguish from general back pain with nerve involvement.
Radiculopathy, unspecified site
Radiculopathy, cervical region
Radiculopathy, cervicothoracic region
Radiculopathy, thoracic region
Radiculopathy, thoracolumbar region
Radiculopathy, lumbar region
Radiculopathy, lumbosacral region
Radiculopathy, sacral and sacrococcygeal region
Coding Tip: Radiculopathy + Cervicalgia
You can bill M54.2 (cervicalgia) and M54.12 (cervical radiculopathy) together. There is nothing under "Excludes 1" prohibiting these codes from being billed on the same claim when both conditions are documented.
Sciatica Codes (M54.3x - M54.4x)
Sciatica is pain radiating from the back into the buttock and posterior/lateral leg. Always specify laterality (right/left) when documented.
| Code | Description | Billable |
|---|---|---|
| M54.30 | Sciatica, unspecified side | Yes |
| M54.31 | Sciatica, right side | Yes |
| M54.32 | Sciatica, left side | Yes |
| M54.40 | Lumbago with sciatica, unspecified side | Yes |
| M54.41 | Lumbago with sciatica, right side | Yes |
| M54.42 | Lumbago with sciatica, left side | Yes |
Sciatica vs. Lumbago with Sciatica
M54.3x (Sciatica alone)
Use when patient has sciatic nerve pain without significant low back pain
M54.4x (Lumbago with sciatica)
Use when patient has both low back pain AND radiating sciatic symptoms
Disc Herniation & Degeneration Codes (M51)
Intervertebral disc disorders require imaging confirmation (MRI/CT). Choose codes based on location, presence of myelopathy or radiculopathy.
| Code | Description | Billable |
|---|---|---|
| M51.06 | Disc disorders with myelopathy, lumbar region | Yes |
| M51.07 | Disc disorders with myelopathy, lumbosacral region | Yes |
| M51.16 | Disc disorders with radiculopathy, lumbar region | Yes |
| M51.17 | Disc disorders with radiculopathy, lumbosacral region | Yes |
| M51.26 | Other disc displacement, lumbar region | Yes |
| M51.27 | Other disc displacement, lumbosacral region | Yes |
| M51.36 | Other disc degeneration, lumbar region | No |
| M51.360 | Disc degeneration, lumbar - discogenic back pain only | Yes |
| M51.361 | Disc degeneration, lumbar - lower extremity pain only | Yes |
| M51.362 | Disc degeneration, lumbar - back and lower extremity pain | Yes |
2024 Update: New Disc Degeneration Codes
Starting October 1, 2024, codes M51.36 and M51.37 were replaced with more specific codes:
- M51.360: Disc degeneration with discogenic back pain only
- M51.361: Disc degeneration with lower extremity pain only
- M51.362: Disc degeneration with both back and lower extremity pain
Spinal Stenosis Codes (M48.0x)
Spinal stenosis codes cover both central canal and foraminal stenosis. For lumbar region, you must specify presence/absence of neurogenic claudication.
| Code | Description | Billable |
|---|---|---|
| M48.02 | Spinal stenosis, cervical region | Yes |
| M48.03 | Spinal stenosis, cervicothoracic region | Yes |
| M48.04 | Spinal stenosis, thoracic region | Yes |
| M48.05 | Spinal stenosis, thoracolumbar region | Yes |
| M48.061 | Spinal stenosis, lumbar - without neurogenic claudication | Yes |
| M48.062 | Spinal stenosis, lumbar - with neurogenic claudication | Yes |
| M48.07 | Spinal stenosis, lumbosacral region | Yes |
| M48.08 | Spinal stenosis, sacral and sacrococcygeal region | Yes |
Lumbar Stenosis: Neurogenic Claudication Required
M48.06 alone is not billable. You must use either M48.061 (without neurogenic claudication) or M48.062 (with neurogenic claudication). Document claudication symptoms: leg pain/weakness with walking that improves with rest or forward flexion.
Chronic Pain Codes (G89)
G89 codes are used in conjunction with site-specific codes to indicate pain chronicity. Important: Provider documentation determines chronicity - there is no specific timeframe.
Other chronic pain
Secondary code when pain is chronic
Chronic pain syndrome
When chronic pain syndrome is documented
Acute pain due to trauma
Acute traumatic pain
Other acute postprocedural pain
Post-surgical pain (non-routine)
G89 Code Sequencing Rules
When treating the underlying condition:
Sequence site-specific code first (e.g., M54.50), then G89.29 as secondary
When pain management is the focus:
Sequence G89.29 first, then the site-specific code as secondary
Do NOT use G89 codes:
For routine/expected postoperative pain or when pain is not specified as acute/chronic
Documentation Best Practices
Required Documentation
- - Specific location (cervical, thoracic, lumbar, lumbosacral)
- - Laterality when applicable (right/left)
- - Acute vs. chronic designation
- - Presence of radiculopathy or myelopathy
- - Neurogenic claudication (for stenosis)
- - Imaging results supporting diagnosis
- - Pain severity and functional impact
Audit Risk Areas
- - Using unspecified codes when specifics available
- - Missing imaging confirmation for disc/stenosis
- - Not specifying laterality for sciatica
- - Using M54.5 (deleted code) instead of M54.5x
- - G89.29 without documented chronicity
- - Coding routine postoperative pain
Low Back Pain Code Selection Guide
Is cause determined?
No → M54.50 | Yes → Continue
Is there vertebral endplate damage with imaging?
Yes → M54.51 | No → Continue
Is there disc herniation/stenosis/other structural cause?
Yes → Use specific M51/M48 code | No → M54.59
Is pain chronic?
Yes → Add G89.29 as secondary code
Frequently Asked Questions
What is the ICD-10 code for low back pain?
The main ICD-10 codes for low back pain are M54.50 (unspecified), M54.51 (vertebrogenic), and M54.59 (other). The old code M54.5 was replaced in 2022 with these three more specific codes. Use M54.50 when the cause is unknown, M54.51 for vertebral endplate-related pain with imaging confirmation, and M54.59 for other specific causes not fitting elsewhere.
What is the ICD-10 code for chronic back pain?
For chronic back pain, use the site-specific code (M54.50, M54.51, or M54.59 for low back) as the primary diagnosis, then add G89.29 (Other chronic pain) as a secondary code. If the encounter is specifically for pain management, sequence G89.29 first. Document chronicity clearly - there is no specific timeframe, but documentation guides code selection.
What is the difference between M54.50 and M54.51?
M54.50 is "Low back pain, unspecified" used when the cause is not yet determined. M54.51 is "Vertebrogenic low back pain" specifically for pain caused by damage to vertebral endplates, requiring imaging confirmation and documentation of deep, burning, or aching pain in the middle lower back. M54.51 has stricter documentation requirements.
What is the ICD-10 code for lumbar disc herniation?
For lumbar disc herniation without myelopathy, use M51.26. With radiculopathy, use M51.16. For lumbosacral region (L5-S1), use M51.17 (with radiculopathy) or M51.27 (without). If myelopathy is present, use M51.06 (lumbar) or M51.07 (lumbosacral). MRI or CT imaging confirmation is required for proper documentation.
What is the ICD-10 code for sciatica?
Sciatica ICD-10 codes are: M54.30 (unspecified side), M54.31 (right side), and M54.32 (left side). For lumbago with sciatica (low back pain plus sciatic symptoms), use M54.40 (unspecified), M54.41 (right), or M54.42 (left). Always specify laterality when documented.
What is the ICD-10 code for lumbar spinal stenosis?
Lumbar spinal stenosis codes are: M48.061 (without neurogenic claudication), M48.062 (with neurogenic claudication), and M48.07 (lumbosacral region). M48.06 alone is not billable - you must specify presence or absence of neurogenic claudication. For cervical stenosis, use M48.02.
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