Back pain remains one of the most common reasons for clinic visits worldwide. Whether caused by muscle strain, disc degeneration, or chronic conditions, every diagnosis requires the correct ICD-10 code for back pain to ensure accuracy, compliance, and reimbursement.
In 2025, the Centers for Medicare and Medicaid Services (CMS) reaffirmed key updates to low back pain classifications. The once-popular code M54.5 (Low back pain) was removed and replaced with more specific options. Using the correct code now prevents claim denials and reflects precise documentation for both acute and chronic cases.
Quick Answer: Current ICD-10 Codes for Back Pain
| Code | Description | Usage |
| M54.50 | Low back pain, unspecified | When no specific cause is identified after evaluation |
| M54.51 | Vertebrogenic low back pain | When imaging confirms vertebral endplate (Modic) changes |
| M54.59 | Other low back pain | For specific patterns not classified under M54.50 or M54.51 |
Why M54.5 Is No Longer Valid
Before 2022, most clinicians used M54.5 for general low back pain. CMS later removed it because it lacked diagnostic precision. Its broad use caused inconsistent documentation and high claim denial rates.
Today, providers must choose the most specific ICD-10 code for lower back pain based on diagnostic findings, imaging results, and symptom presentation.
Understanding Each ICD-10 Code for Lower Back Pain
M54.50 – Low Back Pain, Unspecified
Use this when the patient presents with pain in the lumbar or lumbosacral area without a clear underlying pathology.
Example: Patient complains of dull lower back pain with no history of trauma and normal imaging results.
Documentation tip: Include pain description, duration, and functional limitation. Avoid this code if imaging identifies vertebrogenic or discogenic pathology.
M54.51 – Vertebrogenic Low Back Pain
This code applies when back pain originates from vertebral endplate changes, commonly identified as Modic changes on MRI.
Documentation requirements:
- MRI evidence of Modic Type 1 or Type 2 changes
- Deep, aching lumbar pain without radicular symptoms
- Pain aggravated by sitting or forward flexion
Clinical insight:
Using M54.51 not only improves reimbursement accuracy but also supports better treatment planning, as vertebrogenic pain often responds to targeted interventions like basivertebral nerve ablation.
M54.59 – Other Low Back Pain
Reserved for cases where the pain pattern or etiology is known but not vertebrogenic or unspecified.
Examples:
- Facet joint dysfunction
- Sacroiliac joint pain
- Myofascial lower back pain
Coding tip: Always describe the specific pain source in documentation to justify the use of this code.
Excludes1 Notes: Avoid Common Denials
ICD-10-CM guidelines specify Excludes1 rules, which prevent certain codes from being used together. Misuse triggers automatic rejections.
Do not combine the following:
- M54.50, M54.51, or M54.59 with M54.4- (Lumbago with sciatica)
- M54.5- series with M51.2- (Disc displacement) or M51.1- (Disc disorder with radiculopathy)
- M54.5- series with S39.012 (Low back strain)
Always code the most specific underlying cause instead of pairing overlapping pain codes.
Coding Tips for Back Pain ICD-10
1. Use specificity whenever possible
- If imaging reveals a disc disorder, code it directly (e.g., M51.36-M51.37 for disc degeneration).
- Avoid defaulting to M54.50 unless absolutely necessary.
2. Link clinical documentation clearly
- Describe location, laterality (if applicable), and chronicity.
- Include objective findings such as muscle spasm, tenderness, or range of motion limitation.
3. Pair chronic pain correctly
If chronic pain is clearly documented, add G89.29 (Other chronic pain) as a secondary code. Do not use it as the primary code when the cause is specified.
4. Avoid unspecified codes when tests identify pathology
Unspecified codes may lead to denials if diagnostic results exist in the medical record.
5. Update your code lists annually
CMS releases yearly updates effective each October 1. Always verify against the latest ICD-10-CM version.
Common ICD-10 Codes for Back Pain
| Code | Condition |
| M54.31 | Sciatica, right side |
| M54.32 | Sciatica, left side |
| M54.16 | Lumbar radiculopathy |
| M51.360-M51.379 | Disc degeneration (new 2025 updates) |
| S39.012 | Low back strain |
| M47.26 | Spondylosis with radiculopathy, lumbar region |
| G89.29 | Other chronic pain |
Each of these codes reflects a distinct clinical condition and must align with documentation in the patient’s chart.
2025–2026 Updates: New Disc Degeneration Codes
Effective October 1, 2024, CMS introduced expanded sixth-character detail for lumbar and lumbosacral disc degeneration. These updates differentiate between discogenic pain and lower extremity pain patterns.
Examples:
- M51.360 – Lumbar disc degeneration with discogenic back pain only
- M51.362 – Lumbar disc degeneration with discogenic and lower extremity pain
- M51.370 – Lumbosacral disc degeneration with discogenic pain only
These new codes improve clinical accuracy and payment alignment for intervertebral disc conditions.
Practical Documentation Examples
Scenario 1 – Generalized low back pain:
A 40-year-old patient reports intermittent lower back discomfort for two weeks. No trauma or nerve symptoms.
Code: M54.50
Scenario 2 – Vertebrogenic back pain:
MRI shows Modic Type 2 changes at L4-L5 with localized deep aching pain worsened by sitting.
Code: M54.51
Scenario 3 – Pain linked to facet dysfunction:
Patient has localized right-sided pain with no disc or nerve findings.
Code: M54.59
Scenario 4 – Lumbar radiculopathy:
Imaging confirms disc displacement compressing the L5 nerve root.
Code: M51.16
Best Practices for Accurate ICD-10 Coding
- Review clinical notes before coding to ensure diagnostic detail supports your selection.
- Train staff regularly on annual ICD-10 revisions.
- Use updated EHR lookup tools to prevent obsolete code usage.
- Always check payer policies for modifier or secondary code requirements.
Final Thoughts
Choosing the correct ICD-10 code for back pain is essential for proper documentation, smooth billing, and accurate data reporting. The shift from the retired M54.5 to the newer, more detailed codes like M54.50, M54.51, and M54.59 has made precision more important than ever.
When you document the specific cause and presentation of each patient’s pain, it not only ensures reimbursement accuracy but also improves clinical communication. Staying current with annual CMS updates and applying coding guidelines carefully protects your practice from denials and supports high-quality patient care.
