Is M54.1 a billable ICD-10-CM code?

No. M54.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does M54.1 sit in the tabular list?

Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Other dorsopathies (M50-M54).

What cannot be coded together with M54.1?

M54.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

M54.1

M54.1 — Radiculopathy

Non-billable headerICD-10-CM

M54.1 is a non-billable header ICD-10-CM code for radiculopathy. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

neuralgia and neuritis NOS (M79.2)
radiculopathy with cervical disc disorder (M50.1)
radiculopathy with lumbar and other intervertebral disc disorder (M51.1-)
radiculopathy with spondylosis (M47.2-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Brachial neuritis or radiculitis NOS
Lumbar neuritis or radiculitis NOS
Lumbosacral neuritis or radiculitis NOS
Thoracic neuritis or radiculitis NOS
Radiculitis NOS

Other codes that can never be billed with M54.1

These codes carry an Excludes1 note pointing at M54.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M54.1 alone.

M51.1Thoracic, thoracolumbar and lumbosacral intervertebral disc disorders with radiculopathy
M79.2Neuralgia and neuritis, unspecified
G54Nerve root and plexus disorders

Risk adjustment

M54.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead M54.1

9 child codes. Green means billable.

Related codes at this level

Codes that share M54. If M54.1 is not quite right, the correct code is usually one of these.

Questions about M54.1

Is M54.1 a billable ICD-10-CM code?: No. M54.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does M54.1 sit in the tabular list?: Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Other dorsopathies (M50-M54).
What cannot be coded together with M54.1?: M54.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.