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M54 ICD-10-CM Code: Dorsalgia

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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Other dorsopathies (M50-M54)

M54

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Dorsalgia

Dorsalgia

CMS-HCC V28

N/A

Not mapped

CMS-HCC V24

N/A

Not mapped

ACA/HHS

N/A

Not mapped

ESRD/PACE

N/A

Not mapped

RXHCC

N/A

Not mapped

Code Book Path

Official
M5Other dorsopathies (M50-M54)
M54Dorsalgia

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M54 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M54 in this effective period.

Related Child Codes

Official
M54.0Panniculitis affecting regions of neck and back
M54.1Radiculopathy
M54.2Cervicalgia
M54.3Sciatica
M54.4Lumbago with sciatica

Includes

Official

ICD-10-CM does not list Includes notes for M54 in this effective period.

Excludes 1

Official
  • psychogenic dorsalgia (F45.41)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M54 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M54 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M54 in this effective period.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Coder workflow notes

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What This Code Means

M54 is the ICD-10-CM diagnosis code for dorsalgia. M54 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering other dorsopathies (m50-m54).

Header codes like M54 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at M54's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M54 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Excludes 1, Do NOT code together

  • psychogenic dorsalgia (F45.41)

Child Codes

Code Hierarchy

M54Dorsalgia
M54Dorsalgia

More on M54

Referenced in blog posts

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