M54.5 Diagnosis Code To Be Deleted October 1, 2021

As part of the annual update to the ICD-10 list, the diagnosis code M54.5 will be DELETED as of October 1, 2021.

• This change applies to dates of service October 1, 2021 and later.
• Any claims submitted on or after October 1, 2021 with dates of service PRIOR to October 1, 2021 can still have the M54.5 diagnosis code listed.

For dates of service October 1, 2021, providers should no longer using M54.5. Instead, providers should use one of the below new diagnosis codes:

• M54.50: Low back pain, unspecified
  
• M54.51: Vetebrogenic low back pain
  
• M54.59: Other low back pain

Therefore, for dates of service October 1, 2021 if you are currently using M54.5 for a patient, you must on our online billing form under the New Diagnosis Codes box indicate the new M54.5 code to use.

• For example, enter in the New Diagnosis Codes box: "Use M54.51"
• If you do this, then we will change the M54.5 code to M54.51 for all billings for that patient.
• Only enter this note the first time you submit billing for that patient with a date of service of October 1, 2021 (in other words, do not enter this note every time you submit billing for the patient)
• You do not have to list all other diagnosis codes for the patient unless all other diagnosis codes have changed for the patient since the last visit.

IMPORTANT: If you submit billing for a patient with a date of service of October 1, 2021 and later and you do NOT note a more specific, new M54.5 code to use for the patient we will automatically change to M54.50 (low back pain, unspecified) for that patient.

If you are submitting a new patient form on or after October 1, 2021 and plan on using an M54.5 code, make sure you list one of the new M54.5 diagnosis codes. Do not list M54.5. If you then submit billing with a date of service prior to October 1, 2021, we will ensure we use M54.5 for that date and not use one of the new diagnosis codes.

Thanks,

Steve