Cervicalgia ICD 10 (M54.2) is the official ICD 10 code for neck pain used to report localized, non-radiating cervical spine discomfort. Accurate documentation ensures medical necessity, prevents denials, and supports reimbursement for office visits, therapy, and pain management services.
What Is Cervicalgia ICD 10 (M54.2)?
Cervicalgia is the clinical term for localized neck pain in the cervical spine. It does not involve pain radiating to the arms or hands, which would be coded differently.
Quick Coding Snapshot
ICD 10 Code: M54.2
Description: Cervicalgia (localized neck pain, ICD 10 diagnosis)
Billable: Yes
Use When: Non-radiating neck pain or cervical spine strain
Avoid When: Radiculopathy or neurological deficits are present
Common Settings: Office visits, PT, chiropractic, pain management
This condition may result from:
- Poor ergonomics or posture
- Sudden jerking movements
- Muscle overuse or strain
- Stress-related muscle tension
- Degenerative joint conditions
- Mild herniated disc without neurological compromise
If left untreated, acute pain can develop into chronic neck pain, impacting mobility and quality of life.
Examples of Neck Pain Symptoms
Providers should document symptoms for accurate diagnosis coding. Common symptoms of cervicalgia include:
- Constant dull ache or tightness in the neck
- Difficulty turning the head side to side
- Tenderness in neck muscles
- Pain that worsens with certain movements
- Tension headaches originating from the neck
- Stiffness after sleep or prolonged sitting
In some cases, symptoms may mimic issues from spinal cord involvement, so it’s critical to rule out a neurological cause
ICD-10 Code for Cervicalgia: M54.2
| ICD-10 Code | Description | Billable | Category |
|---|---|---|---|
| M54.2 | Cervicalgia (Neck Pain) | Yes | Musculoskeletal system |
This code belongs to Chapter 13 of ICD-10-CM, which covers musculoskeletal system and connective tissue disorders. It is used for reimbursement when the patient’s diagnosis is neck pain without nerve root involvement.
When to Use ICD-10 Code M54.2
Use this code when the patient presents with localized neck pain without radiating symptoms. Physical examination or imaging should confirm the absence of nerve root compression or spinal cord injury. This includes cases caused by poor posture, repetitive movement, or muscular strain.
If pain radiates or is linked to a herniated disc with neurological findings, select a more specific diagnosis code.
When Should You Use Cervicalgia ICD 10 for Chronic Neck Pain?
Cervicalgia (M54.2) may also be used for chronic neck pain when symptoms remain localized and non-radiating. Document duration, failed conservative care, and functional limitations to justify ongoing treatment and reimbursement.
M54.2 vs M54.12: Which ICD 10 Code Should You Use?
Choosing the correct diagnosis between cervicalgia ICD 10 and cervical radiculopathy affects both compliance and reimbursement. Use the table below to quickly determine which ICD 10 code for neck pain fits the patient’s presentation.
| Feature | M54.2 Cervicalgia | M54.12 Cervical Radiculopathy |
|---|---|---|
| Condition Type | Localized neck pain | Neck pain with nerve root involvement |
| Pain Location | Neck only | Neck plus arm or shoulder radiation |
| Neurological Symptoms | None | Numbness, tingling, weakness, reflex changes |
| Cause | Muscle strain, posture, soft tissue injury | Disc herniation, nerve compression, spinal stenosis |
| Imaging Findings | Often normal or mild degenerative changes | Nerve root compression or disc pathology |
| Billable | Yes | Yes |
| Typical Treatments | PT, manual therapy, NSAIDs, muscle relaxers | Imaging, injections, specialist referral, possible surgery |
| Coding Risk | Overuse may trigger medical necessity review | Undercoding may reduce reimbursement |
| When to Use | Non-radiating neck pain cases only | Radiating pain or neurological deficits present |
| Common Settings | Office visits, chiropractic, physical therapy | Neurology, orthopedics, pain management |
Quick Rule:
If pain stays in the neck → use cervicalgia ICD 10 (M54.2)
If pain travels down the arm → use M54.12
If documentation supports nerve involvement or radiating symptoms, avoid using M54.2 and select the radiculopathy code instead to prevent mismatched severity reviews.
Pro Tip:
Misclassifying radiculopathy under M54.2 is a common denial trigger because high-cost services like imaging or injections may not match the diagnosis severity.
How Is Cervicalgia Different From Radiculopathy?
Cervicalgia ICD 10 (M54.2) may also be used for chronic neck pain ICD 10 cases when symptoms remain localized and non-radiating. Providers should document duration, failed conservative treatments, and functional limitations to justify ongoing therapy or repeated visits.
Coding Tips for ICD-10 Code M54.2
- Document symptom duration, location, and aggravating factors
- Rule out complex neurological conditions when applicable
- Include specific findings that support medical necessity
- If prescribing muscle relaxers or anti-inflammatories, document medication type and clinical justification
- Avoid repeated use without updated progress notes
CPT Codes Often Billed With M54.2
Correct coding depends on both proper diagnosis and documentation.
Here’s how to ensure accurate use:
| CPT Code | Service |
|---|---|
| 99213 | Established patient office visit |
| 97110 | Therapeutic exercises |
| 97140 | Manual therapy |
| 20552 | Trigger point injections |
Pairing CPT and ICD-10 codes accurately supports medical necessity and speeds up reimbursement.
Insurance and Reimbursement Guidelines
Most insurance company policies, including Medicare, recognize M54.2 as a valid diagnosis for office visits, chiropractic care, physical therapy, and pain management. Documentation must establish medical necessity. Overuse without documented improvement can result in additional scrutiny.
Documentation Requirements
Before submitting a claim, ensure documentation includes:
- Pain description (dull, sharp, aching)
- Duration and onset
- Functional limitations
- Clinical findings from examination or imaging
- Treatments provided (including muscle relaxers, anti-inflammatories, manual therapy, or exercise programs)
ProMBS Tip: Strong, detailed documentation increases first-pass acceptance and reduces payer audits.
Let ProMBS Help You Code with Confidence
Our billing experts understand the nuances of ICD-10 coding and payer-specific policies. At Pro-MBS, we take a detailed approach to ensure your claims are coded, documented, and submitted properly, so your practice can focus on care, not denials.
Insight:
Based on recent Pro-MBS audits, nearly 20% of cervicalgia ICD 10 denials occur due to missing functional limitation or duration documentation. Adding onset, exam findings, and therapy plans significantly improves first-pass approvals.
Reviewed by certified medical billing specialists with 10+ years of U.S. revenue cycle experience. Coding guidance follows official documentation standards published by the Centers for Medicare & Medicaid Services and the ICD-10-CM Official Guidelines for Reporting.
Final Thoughts
Accurate cervicalgia ICD 10 coding protects both reimbursement and compliance. When documentation, diagnosis, and treatment align, claims process faster, denials decrease, and revenue remains predictable. The proper use of M54.2 ensures not only accurate payment but also compliance with payer expectations.
Frequently Asked Questions
What is the ICD 10 code for cervicalgia?
The ICD 10 code for cervicalgia is M54.2. It is a billable diagnosis used to report localized, non-radiating neck pain. Providers use this code when symptoms are limited to the cervical spine and no neurological involvement or nerve root compression is documented.
Is cervicalgia ICD 10 (M54.2) a billable code?
Yes. Code M54.2 is billable and accepted by Medicare and most commercial payers. It supports reimbursement for office visits, physical therapy, chiropractic care, and pain management services when documentation clearly establishes medical necessity.
When should you not use cervicalgia ICD 10?
Do not use M54.2 when pain radiates to the arm or when neurological symptoms such as numbness, weakness, or tingling are present. These findings suggest cervical radiculopathy or spinal nerve involvement, which requires a more specific diagnosis code.
Which CPT codes pair with cervicalgia ICD 10?
Common CPT codes billed with cervicalgia ICD 10 include 99213 for office visits, 97110 for therapeutic exercises, 97140 for manual therapy, and 20552 for trigger point injections. Each service must be supported by documentation that explains the treatment plan and medical necessity.
How does documentation support medical necessity for neck pain claims?
Documentation should include pain location, onset, duration, functional limitations, exam findings, and treatments provided. Clear clinical detail shows why services such as therapy, injections, or medications were required, helping prevent denials and speeding up reimbursement.
Can cervicalgia ICD 10 be used for chronic neck pain?
Yes. M54.2 may be used for chronic neck pain if symptoms remain localized and no nerve involvement exists. However, providers should document symptom duration, prior treatments, and functional impact to justify ongoing care and avoid payer scrutiny.
What is the ICD 10 code for neck pain?
The ICD 10 code for neck pain is M54.2, also known as cervicalgia ICD 10. It is used when pain is localized to the cervical spine without nerve root involvement or radiating symptoms.