M54.13: Radiculopathy, cervicothoracic region

M54.13, radiculopathy, cervicothoracic region, is listed as a covered diagnosis in 12 Medicare billing and coding articles that apply to 27 HCPCS Level II codes, including G0283 (Electrical stimulation (unattended), to one or more areas…), G0410 (Group psychotherapy other than of a multiple-family group…), G0017 (Psychotherapy for crisis furnished in an applicable site…). 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 6 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 M54.13 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of careCarrier judgment—4
G0410Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutesCarrier judgment—1
G0017Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutesCarrier judgment—1
G0018Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service)Carrier judgment—1
G0411Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutesCarrier judgment—1
G0453Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)Carrier judgment—1
E0783Infusion 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
E0786Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)Special coverage instructions apply$10,969.75–$11,380.88 (NU)1
E0782Infusion 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
E0785Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacementSpecial coverage instructions apply$572.38–$673.39 (KF)1
J7999Compounded drug, not otherwise classifiedSpecial coverage instructions apply—1
J2278Injection, ziconotide, 1 microgramSpecial coverage instructions apply—1
J2274Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mgSpecial coverage instructions apply—1
A4220Refill kit for implantable infusion pumpSpecial coverage instructions apply—1
J9200Injection, floxuridine, 500 mgSpecial coverage instructions apply—1
G0281Electrical 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 careCarrier judgment—2
G0329Electromagnetic 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 careCarrier judgment—2
G0152Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutesCarrier judgment—1
G0158Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutesCarrier judgment—1
G0160Services 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 minutesCarrier judgment—1
G2169Services 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 minutesCarrier judgment—1
G2010Remote 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 appointmentCarrier judgment—1
G2250Remote 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 appointmentCarrier judgment—1
G2251Brief 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 discussionCarrier judgment—1
G0151Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutesCarrier judgment—1

2 more codes are listed. See every code with payment by region in Caduvo.

Medicare policy articles listing M54.13

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)

Frequently asked questions

Does Medicare cover M54.13 (Radiculopathy, cervicothoracic region)?

Medicare covers items and services, not diagnoses. 12 Medicare billing and coding articles list M54.13 as a covered diagnosis for 27 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 M54.13?

The Level II codes from the policies most specific to this diagnosis are G0283 (Electrical stimulation (unattended), to one or more areas…, 4 articles); G0410 (Group psychotherapy other than of a multiple-family group…, 1 article); G0017 (Psychotherapy for crisis furnished in an applicable site…, 1 article); G0018 (Psychotherapy for crisis furnished in an applicable site…, 1 article); G0411 (Interactive group psychotherapy, in a partial…, 1 article). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with M54.13?

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 M54.13?

A56034 (Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy); A57480 (Billing and Coding: Psychiatry and Psychology Services); A56722 (Billing and Coding: Intraoperative Neurophysiological Testing), and 9 more articles.

What is ICD-10-CM code M54.13?

M54.13 is the ICD-10-CM code for radiculopathy, cervicothoracic region, in category M54 (Dorsalgia), chapter 13: Diseases of the musculoskeletal system and connective tissue.

Next steps

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