M54.6 — Pain in thoracic spine
M54.6 is a billable, specific ICD-10-CM code for pain in thoracic spine. It is valid for submission on a claim.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- pain in thoracic spine due to intervertebral disc disorder (M51.-)
Other codes that can never be billed with M54.6
These codes carry an Excludes1 note pointing at M54.6. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M54.6 alone.
- M54.8Other dorsalgia
Risk adjustment
M54.6 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.
Medicare coverage
M54.6 is named in 35 Medicare coverage policies — 29 listing it as supporting medical necessity, and 6 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
How M54.6 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to M54.6.
- Pain›thoracic spine
- Pain›spine›thoracic
Related codes at this level
Codes that share M54. If M54.6 is not quite right, the correct code is usually one of these.
Questions about M54.6
- Is M54.6 a billable ICD-10-CM code?
- Yes. M54.6 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M54.6 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 M54.6?
- M54.6 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.