• June 13, 2024

Cervicalgia ICD-10 CODE M54.2 (2025) – Complete Guide

Cervicalgia ICD-10 CODE M54.2 - ICD 10 code for Neck pain
Cervicalgia ICD-10 CODE M54.2 - ICD 10 code for Neck pain

Cervicalgia ICD-10 Code M54.2:Guide for Accurate Medical Billing

Cervicalgia, or neck pain, is one of the most frequently reported musculoskeletal complaints in medical practices. Whether caused by posture, injury, or aging, neck pain requires accurate documentation and coding for proper reimbursement. The ICD-10 code for cervicalgia is M54.2, and understanding how and when to use it can help ensure clean claims and faster payments. Key Points
  • ICD-10 Code: M54.2
  • Definition: Cervicalgia refers to non-radiating neck pain
  • Billable: Yes
  • Used For: Office visits, chiropractic care, physical therapy, and pain management
  • Common Causes: Muscle strain, poor posture, whiplash, or arthritis
  • Excludes: Radiating pain due to nerve involvement (e.g., cervical radiculopathy)
  • Documentation Must Include: Onset, symptom type, duration, limitations, and clinical findings

What Is Cervicalgia?

Cervicalgia is the clinical term for neck pain that is localized to the cervical spine. It does not involve pain traveling to the arms or hands, which would be coded differently. Cervicalgia may result from:
  • Poor ergonomics or posture
  • Sudden jerking movements
  • Muscle overuse or strain
  • Stress-related muscle tension
  • Degenerative joint conditions

Examples of Neck Pain Symptoms

Physicians 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 long periods of sitting

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 includes diseases of the musculoskeletal system and connective tissue. It is used for reimbursement when the patient’s diagnosis is neck pain without nerve involvement.

When to Use M54.2

Use this code when the patient presents with neck pain that does not involve radiating symptoms. The pain should be localized to the cervical region and confirmed through physical examination or imaging that rules out disc herniation or neurological involvement. This includes cases where the pain stems from poor posture, repetitive movement, or muscular strain. If symptoms extend into the shoulders or arms or if diagnostic imaging shows spinal compression or disc-related issues, a more specific code should be used instead.

Coding Tips for M54.2

Correct coding depends on both proper diagnosis and documentation. Here’s how to ensure accurate use:
  • Document symptom duration and location
  • Include information on triggering factors like movement or posture
  • Rule out more complex diagnoses when applicable
  • Pair M54.2 with appropriate CPT codes and treatment details
  • Avoid using it repeatedly 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:
  • Document symptom duration and location
  • Include information on triggering factors like movement or posture
  • Rule out more complex diagnoses when applicable
  • Pair M54.2 with appropriate CPT codes and treatment details
  • Avoid using it repeatedly without updated progress notes
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 plans, including Medicare and commercial payers, recognize M54.2 as a valid diagnosis for office visits, physical therapy, chiropractic services, and pain management interventions. However, documentation must support the reason for the visit and show medical necessity. Claims are more likely to be denied if the diagnosis is vague, overused, or not tied to a relevant service. If the same diagnosis is submitted repeatedly without evidence of change in condition or treatment plan, it may prompt further review.

To avoid billing errors, providers should refrain from using M54.2 for nerve-related conditions and avoid generic statements such as "neck pain" without clinical details. Every encounter note should reflect the current status of the patient’s symptoms and response to treatment.

Documentation Requirements

Before submitting a claim with this code, ensure the documentation includes a description of the patient’s symptoms, such as dull, aching, or sharp pain. The provider should record how the pain affects movement, what aggravates or improves it, and how it impacts the patient’s daily routine. Any treatment rendered, such as manual therapy or medication, must be documented in the visit note.

Including these elements helps demonstrate medical necessity and reduces the chance of claim denial or delay.

ProMBS Tip: Strong documentation increases first-pass claim acceptance and reduces audit risk.

Let ProMBS Help You Code with Confidence

Our billing experts understand the nuances of ICD-10 coding and payer-specific policies. At ProMBS, we take a detailed approach to ensure your claims are coded, documented, and submitted properly, so your practice can focus on care, not denials.
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Final Thoughts

Cervicalgia may seem like a minor condition, but in billing, it carries major importance. The proper use of M54.2 ensures not only accurate payment but also compliance with payer expectations.