M54.04: Panniculitis affecting regions of neck and back, thoracic region
M54.04, panniculitis affecting regions of neck and back, thoracic region, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 20 HCPCS Level II codes, including G0283 (Electrical stimulation (unattended), to one or more areas…), E0783 (Infusion pump system, implantable, programmable (includes…), E0786 (Implantable programmable infusion pump, replacement…). 4 of these codes have a 2026 DMEPOS fee schedule amount; E0783 pays $9,917.33 to $11,667.45 (NU) depending on the state. The articles come from 2 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with M54.04 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | Carrier judgment | — | 3 |
| E0783 | Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.) | Special coverage instructions apply | $9,917.33–$11,667.45 (NU) | 1 |
| E0786 | Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) | Special coverage instructions apply | $10,969.75–$11,380.88 (NU) | 1 |
| E0782 | Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.) | Special coverage instructions apply | $5,200.92–$6,118.73 (NU) | 1 |
| E0785 | Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement | Special coverage instructions apply | $572.38–$673.39 (KF) | 1 |
| J7999 | Compounded drug, not otherwise classified | Special coverage instructions apply | — | 1 |
| J2278 | Injection, ziconotide, 1 microgram | Special coverage instructions apply | — | 1 |
| J2274 | Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg | Special coverage instructions apply | — | 1 |
| A4220 | Refill kit for implantable infusion pump | Special coverage instructions apply | — | 1 |
| J9200 | Injection, floxuridine, 500 mg | Special coverage instructions apply | — | 1 |
| G0281 | Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care | Carrier judgment | — | 2 |
| G0329 | Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care | Carrier judgment | — | 2 |
| G0152 | Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
| G0158 | Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
| G0160 | Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes | Carrier judgment | — | 1 |
| G2169 | Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes | Carrier judgment | — | 1 |
| G2010 | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment | Carrier judgment | — | 1 |
| G2250 | Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment | Carrier judgment | — | 1 |
| G2251 | Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion | Carrier judgment | — | 1 |
| G0151 | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
Medicare policy articles listing M54.04
- A56695: Billing and Coding: Implantable Infusion Pump (Palmetto GBA (MAC - Part B); 9 Level II codes). LCD with the same title: L33461
- A53057: Billing and Coding: Home Health Occupational Therapy (Palmetto GBA (HHH MAC); 5 Level II codes). LCD with the same title: L34560
- A53064: Billing and Coding: Outpatient Occupational Therapy (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34427
- A57311: Billing and Coding: Physical Therapy - Home Health (CGS Administrators, LLC (HHH MAC); 7 Level II codes). LCD with the same title: L33942
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other M54 diagnoses (Dorsalgia)
- M54.03 — Panniculitis affecting regions of neck and back, cervicothoracic…
- M54.05 — Panniculitis affecting regions of neck and back, thoracolumbar region
- M54.06 — Panniculitis affecting regions of neck and back, lumbar region
- M54.07 — Panniculitis affecting regions of neck and back, lumbosacral region
- M54.08 — Panniculitis affecting regions of neck and back, sacral and…
- M54.09 — Panniculitis affecting regions, neck and back, multiple sites in spine
- M54.10 — Radiculopathy, site unspecified
- M54.11 — Radiculopathy, occipito-atlanto-axial region
- M54.12 — Radiculopathy, cervical region
- M54.13 — Radiculopathy, cervicothoracic region
- M54.14 — Radiculopathy, thoracic region
- M54.15 — Radiculopathy, thoracolumbar region
- M54.16 — Radiculopathy, lumbar region
- M54.17 — Radiculopathy, lumbosacral region
- M54.18 — Radiculopathy, sacral and sacrococcygeal region
- M54.2 — Cervicalgia
- M54.31 — Sciatica, right side
- M54.32 — Sciatica, left side
- M54.41 — Lumbago with sciatica, right side
- M54.42 — Lumbago with sciatica, left side
- M54.50 — Low back pain, unspecified
- M54.51 — Vertebrogenic low back pain
- M54.59 — Other low back pain
- M54.6 — Pain in thoracic spine
- M54.89 — Other dorsalgia
- M54.9 — Dorsalgia, unspecified
Frequently asked questions
Does Medicare cover M54.04 (Panniculitis affecting regions of neck and back, thoracic…)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list M54.04 as a covered diagnosis for 20 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 M54.04?
The Level II codes from the policies most specific to this diagnosis are G0283 (Electrical stimulation (unattended), to one or more areas…, 3 articles); E0783 (Infusion pump system, implantable, programmable (includes…, 1 article); E0786 (Implantable programmable infusion pump, replacement…, 1 article); E0782 (Infusion pump, implantable, non-programmable (includes all…, 1 article); E0785 (Implantable intraspinal (epidural/intrathecal) catheter…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with M54.04?
Under the 2026 DMEPOS fee schedule (non-rural state fees): E0783 $9,917.33 to $11,667.45 (NU); E0786 $10,969.75 to $11,380.88 (NU); E0782 $5,200.92 to $6,118.73 (NU); E0785 $572.38 to $673.39 (KF). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list M54.04?
A56695 (Billing and Coding: Implantable Infusion Pump); A53057 (Billing and Coding: Home Health Occupational Therapy); A53064 (Billing and Coding: Outpatient Occupational Therapy), and 1 more article.
What is ICD-10-CM code M54.04?
M54.04 is the ICD-10-CM code for panniculitis affecting regions of neck and back, thoracic region, in category M54 (Dorsalgia), chapter 13: Diseases of the musculoskeletal system and connective tissue.
Next steps
- Run a reimbursement report for a device billed under G0283
- Watch G0283 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0283
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 13: Diseases of the musculoskeletal system and connective tissue · All diagnoses · HCPCS lookup