ICD-10-CM · Spine

M54.51

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.

Verified May 8, 2026 · 7 sources ↓

Status: Billable
Chapter: 13
Related CPT: 19
Region: Spine

Drawn from CDCICD10DataCMSRapidclaimsHellonote

Documentation tips

What should appear in the chart to support M54.51.

Source · Editorial brief grounded in 7 cited references ↓

Provider must explicitly name 'vertebrogenic' etiology or document vertebral endplate pathology — generic 'low back pain' language defaults the coder to M54.50, not M54.51.
Reference specific imaging findings that support vertebrogenic origin: Modic type (I, II, or III), endplate irregularity, or adjacent bone marrow signal change on MRI.
Record functional limitations (e.g., inability to stand >20 minutes, restricted lumbar ROM) to substantiate medical necessity for associated procedures or therapy.
When ordering MRI lumbar spine, note in the assessment/plan that imaging is being used to characterize vertebral endplate involvement — this links the diagnostic CPT to M54.51 cleanly.
If the encounter is for pain management, sequence the G89 pain code correctly: G89 first when pain management is the reason for the visit, M54.51 second as the site-specific code.
Document prior conservative care history (physical therapy, NSAIDs, duration) if the plan includes interventional procedures — payers increasingly require this under LCD policies for spinal injections.

Related CPT procedures

Procedure codes commonly billed with M54.51. Linking the right diagnosis to the right procedure is what establishes medical necessity.

Source · CMS LCDs · AAOS specialty guidance · claims-pattern analysis

72148 $191.72

Non-contrast MRI of the lumbar spine used to evaluate disc pathology, spinal stenosis, nerve root compression, and other structural abnormalities without administration of contrast material.

72158 $318.31

MRI of the lumbar spinal canal and its contents performed first without contrast, then repeated after contrast administration for enhanced visualization.

72100 $40.42

Radiologic examination of the lumbosacral spine capturing two or three views, used to evaluate the lumbar vertebrae and sacrum for injury, degeneration, or structural abnormality.

72110 $53.44

Radiologic examination of the lumbar spine (lumbosacral) with a minimum of four views, including oblique and/or bending views.

99203 $117.57

New patient office or outpatient visit requiring a medically appropriate history and/or examination with low-complexity medical decision-making, or 30–44 minutes of total provider time on the date of the encounter.

99204 $177.36

New patient office or outpatient visit requiring moderate medical decision making, or 45–59 minutes of total provider time on the date of the encounter.

99205 $236.81

New patient office or outpatient visit requiring high-complexity medical decision making, or 60–74 minutes of total time on the date of encounter.

99213 $95.19

Established patient office or outpatient visit requiring 20–29 minutes of total time or low-complexity medical decision-making.

99214 $135.61

Office visit for an established patient requiring moderate-complexity medical decision making (MDM), or 30–39 minutes of total provider time on the date of service.

99215 $192.39

Highest-level office or outpatient E/M visit for an established patient, qualifying via high-complexity medical decision making or 40–54 minutes of total provider time on the date of service.

97161 $97.86

Low-complexity physical therapy evaluation covering a history with no or minimal comorbidities affecting the plan of care, examination of 1–2 elements (body structures/functions, activity limitations, and/or participation restrictions), a stable and uncomplicated clinical presentation, and low-complexity clinical decision-making. Typically 20 minutes face-to-face.

97162 $97.86

Moderate-complexity physical therapy evaluation requiring documented history with one to two comorbidities or personal factors, examination of three or more body system elements with measurable findings, and moderate clinical decision-making for an evolving presentation — typically 30 minutes face-to-face.

97163 $97.86

High-complexity physical therapy evaluation requiring documentation of three or more personal factors or comorbidities affecting the plan of care, examination of four or more body system elements using standardized tests and measures, and an unstable or unpredictable clinical presentation — typically 45 minutes face-to-face.

97110 $29.06

Therapeutic exercise billed per 15-minute unit, targeting strength, endurance, range of motion, or flexibility with direct one-on-one patient contact.

97140 $27.72

Skilled, hands-on manual therapy techniques — including joint mobilization/manipulation, manual lymphatic drainage, and manual traction — applied to one or more body regions, billed per 15-minute unit.

99202 View procedure details

99212 View procedure details

62323 View procedure details

62321 View procedure details

Common coding pitfalls

The recurring mistakes coders make with M54.51 and adjacent codes.

Source · Editorial brief grounded in CDC ICD-10-CM tabular guidance, AAOS coding references, and cited references ↓

Assigning M54.51 when the note documents only 'low back pain' without provider attribution to a vertebrogenic source — that encounter codes to M54.50 or M54.59, not M54.51.
Using M54.51 alongside M51.360 or M51.370 when discogenic pain from documented lumbar disc degeneration is the primary driver — those codes are mutually exclusive per Tabular List excludes notes.
Continuing to bill the retired M54.5 parent code — it became non-billable in FY2022; claims with M54.5 on or after October 1, 2021 will reject.
Pairing M54.51 with M54.4- (lumbago with sciatica) or M51.2- (disc displacement) for the same encounter when those conditions are the documented primary diagnosis rather than a co-existing vertebrogenic component.
Omitting the G89 secondary code when the encounter purpose is pain management — missing this code leaves clinical complexity undercoded and may affect reimbursement for higher-complexity visits.

Clinical context

Source · Editorial summary grounded in 7 cited references ↓

M54.51 is the correct code when the provider explicitly attributes low back pain to a vertebrogenic source, typically supported by MRI findings such as Modic type I or II changes, vertebral endplate irregularities, or other imaging evidence of vertebral structural pathology. Assign it only when the documentation names vertebrogenic etiology — not when the note simply describes axial LBP without a defined source.

This code was introduced in the FY2022 expansion that retired the old billable M54.5 and split it into three specific child codes: M54.50 (unspecified), M54.51 (vertebrogenic), and M54.59 (other low back pain). Defaulting to M54.50 when vertebrogenic findings are documented in the note is a specificity error that exposes the claim to payer scrutiny. Reserve M54.50 strictly for encounters where etiology is genuinely undocumented.

Important exclusions under parent M54.5: do not use M54.51 when the primary driver is intervertebral disc displacement (use M51.2-), lumbago with sciatica (M54.4-), lumbar radiculopathy (M54.16), or discogenic pain from documented disc degeneration with Modic changes coded under M51.360 or M51.370. If the encounter is for pain management rather than diagnostic evaluation, add a G89 pain category code as a secondary code per ICD-10-CM official pain guidelines.

Inclusion & exclusion notes

Per the official ICD-10-CM Tabular List.

Source · CDC ICD-10-CM Official Tabular List · 2026

Includes

Low back vertebral endplate pain

Sibling codes

Other billable codes under M54.5 (laterality / anatomic variants).

M54.59

Other low back pain

M54.50

Low back pain, unspecified

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the clinical definition of vertebrogenic low back pain for coding purposes?

Vertebrogenic low back pain is axial LBP attributable to pathology of the vertebral structures — most specifically vertebral endplate changes, often associated with Modic type I or II findings on MRI. The provider, not the coder, makes this determination based on clinical evaluation and imaging.

02When did M54.51 become a valid billable code?

M54.51 became effective October 1, 2021 (FY2022 ICD-10-CM update), when CMS retired the previously billable M54.5 and introduced three specific child codes: M54.50, M54.51, and M54.59.

03Can I use M54.51 when the MRI shows disc herniation causing low back pain?

No. If the documented driver is intervertebral disc displacement, use M51.2- (lumbago due to disc displacement). M54.51 is reserved for vertebrogenic sources — endplate and vertebral body pathology — not disc herniation or protrusion.

04Should M54.51 be coded with a G89 pain code?

Only when the encounter is specifically for pain management or pain control. In that scenario, sequence G89 (e.g., G89.29 for other chronic pain) first and M54.51 second. For diagnostic or routine follow-up visits, M54.51 alone is sufficient.

05What is the difference between M54.51 and M54.59?

M54.51 requires documented vertebrogenic etiology — provider-identified vertebral endplate or structural pathology. M54.59 captures other defined low back pain patterns (mechanical, muscular, facet-mediated, sacroiliac) that have a described character but do not meet vertebrogenic criteria.

06Which CPT codes are most commonly paired with M54.51?

Lumbar spine MRI (72148, 72158), lumbar X-ray (72100, 72110), E/M office visits (99202–99215), physical therapy evaluation and treatment (97161–97163, 97110, 97140), and lumbar epidural steroid injections (62321, 62323) are frequent pairings when medically documented.

07Can M54.51 be used as a secondary code?

Yes. If the primary reason for the encounter is a procedure or a different condition and vertebrogenic low back pain is a co-existing diagnosis affecting care, list M54.51 as an additional diagnosis per ICD-10-CM official reporting guidelines for additional diagnoses.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

The Mira AI Scribe captures the provider's explicit attribution of low back pain to vertebral endplate pathology, pulls MRI findings (Modic type, endplate signal change, adjacent marrow edema), and records functional impact and prior conservative care attempts. This prevents the note from defaulting to unspecified M54.50, eliminates payer mismatches between diagnosis and procedure, and supports medical necessity for interventional or advanced imaging services.

See how Mira captures M54.51 documentation