M54.12: Radiculopathy, cervical region

The ICD-10-CM code for cervical radiculopathy when the provider documents irritation or compression of a cervical nerve root producing radicular arm pain, numbness or weakness. No cervical disc disorder or spondylosis is documented as the cause.

Billable

FY2027

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At a glance

Code Family

M54.1: Radiculopathy, classified by spinal region.

Condition

Cervical radiculopathy

DRG Grouping

MS-DRG 073 or 074 under MDC 01, Diseases and Disorders of the Nervous System, in the FY2027 MS-DRG v44 grouper.

HCC Mapping (v28)

No HCC mapping. M54.12 does not map to any CMS-HCC v28 category, and carried no mapping under v24 either.

Family Specificity

Billable region-specific child code. The parent M54.1 is non-billable. Only the region-specific children are reportable.

Effective Date

Valid in the FY2026 code set and unchanged in the FY2027 update.

Which radiculopathy code do I assign?

The M54.1 subcategory assigns radiculopathy by the spinal region the note documents. Before choosing any of these codes, confirm that no intervertebral disc disorder and no spondylosis is documented as the cause, because those findings move the encounter to M50.1-, M51.1- or M47.2- instead.

When documentation says…

Code

Radicular arm pain and paresthesia from a cervical nerve root, no structural cause identified

M54.12

Radiculopathy documented at the cervical region, covering the C3 to C7 levels. The note must state radiculopathy as the diagnosis. It must also show cervical nerve root findings such as dermatomal arm pain, sensory change or weakness.

Radiculopathy of the occipito-atlanto-axial region

M54.11

Radiculopathy documented at the C0 to C2 levels. Assign it when the record places the nerve root involvement above the mid-cervical spine.

Radiculopathy at the cervicothoracic junction

M54.13

Radiculopathy documented at the C7 to T1 junction. Assign it when the record names the cervicothoracic region rather than the cervical region alone.

Cervical radiculopathy with a documented cervical disc disorder

M50.12-

Cervical disc disorder with radiculopathy, mid-cervical region. Once a disc disorder is documented as the cause, the Excludes1 note at M54.1 bars M54.12 for the same condition. Select the M50.1- code that matches the documented level, whether M50.11, M50.12-, M50.13 or M50.10.

Cervical radiculopathy attributed to cervical spondylosis

M47.22

Other spondylosis with radiculopathy, cervical region. Assign it when spondylosis is documented as the cause of the radiculopathy.

Neck pain without arm symptoms

M54.2

Cervicalgia. Assign it when the record documents localized neck pain and no radicular features.

Radiculopathy documented with no spinal region stated

M54.10

The residual code, used only when the record gives no region. Do not default to it when cervical involvement is documented, because that loses the regional specificity the family is built to capture.

Tabular notes

EXCLUDES1 AT THE M54.1 SUBCATEGORY LEVEL

Neuralgia and neuritis NOS (M79.2). Radiculopathy with cervical disc disorder (M50.1). Radiculopathy with lumbar and other intervertebral disc disorder (the M51.1 codes). Radiculopathy with spondylosis (the M47.2 codes). These are Excludes1 notes. When a cervical disc disorder is the documented cause of the radiculopathy, report the M50.1- code instead of M54.12. When cervical spondylosis is the documented cause, report M47.22 instead. M54.12 is not reported with an M50.1-, M51.1- or M47.2- code for the same radiculopathy. Guideline I.A.12.a allows both codes when the conditions are unrelated.

NO EXCLUDES2, USE ADDITIONAL OR CODE FIRST

The FY2027 tabular carries no Excludes2 notes, no Use Additional instructions, no Code Also instructions and no Code First requirements at the M54.12 code level. Chapter 13 carries a general note to use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause.

FY2027: EFFECTIVE 1 OCTOBER 2026

None. The FY2027 codes addenda add, delete or revise no code in subcategory M54.1. The FY2027 tabular addenda change no note at M54 or M54.1. M54.12 is unchanged in the FY2027 update.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

No HCC mapping applies. M54.12 does not map to any Hierarchical Condition Category in CMS-HCC Model Version 28, and it carried no mapping under the prior v24 model.

Reporting M54.12 does not contribute to a beneficiary's risk score and does not generate HCC credit for a Medicare Advantage plan.

The structural causes of cervical radiculopathy are not HCC-mapped either. Stepping the code up to M50.1- or M47.22 does not add risk adjustment weight.

MS-DRG ASSIGNMENT: FY2027 (V44)

MS-DRG 073: Cranial and peripheral nerve disorders with MCC.

MS-DRG 074: Cranial and peripheral nerve disorders without MCC.

M54.12 as a principal inpatient diagnosis groups to MDC 01, Diseases and Disorders of the Nervous System, rather than to MDC 08, Diseases and Disorders of the Musculoskeletal System and Connective Tissue. The grouper places M54.12 there even though the code sits in Chapter 13. The placement does not extend to every radiculopathy code: M54.16, lumbar radiculopathy, groups to MS-DRG 551 or 552 in MDC 08. Cervical disc disorder with radiculopathy, coded to the M50.1 subcategory, groups instead to MS-DRG 551 or 552, medical back problems, in MDC 08.

MEDICARE AND COMMERCIAL PAYERS

There is no National Coverage Determination specific to M54.12. The code supports medical necessity documentation for cervical spine MRI, for electrodiagnostic studies such as EMG and nerve conduction testing, for physical therapy and for cervical epidural steroid injection.

WHERE SPECIFICITY IS LOST

Two selections put a cervical radiculopathy claim at odds with the tabular. The first is defaulting to M54.10 when the cervical region is documented. The second is reporting M54.12 alongside an M50.1- code when a disc disorder is the documented cause.

Expecting an MDC 08 grouping for an inpatient stay principally coded to M54.12 misstates the DRG weight, because the code groups to MDC 01.

Documentation checklist to support M54.12

Chart elements that support code selection and reduce specificity-driven denials.

Provider documentation of cervical radiculopathy, cervical nerve root compression or cervical nerve root irritation, stated as the diagnosis rather than as neck pain.

Clinical findings consistent with cervical nerve root involvement, such as dermatomal arm pain, paresthesia, sensory change or weakness.

Confirmation that no cervical disc disorder is documented as the etiology at the time of coding, since an identified disc disorder moves the encounter to the M50.1- codes under the Excludes1 rule.

Confirmation that cervical spondylosis is not documented as the cause, which would direct the encounter to M47.22.

The documented spinal level where the record supports it, to separate C3 to C7 cervical involvement from the occipito-atlanto-axial and cervicothoracic levels.

A clear distinction between radicular symptoms and localized neck pain, because cervicalgia without radicular features is coded to M54.2.

A plan to update the code to the causative code at subsequent encounters if imaging or further evaluation identifies a disc disorder or spondylosis as the cause.

Sequencing of M54.12 as the principal or primary diagnosis when cervical radiculopathy is the reason for the encounter and no underlying disc disorder or spondylosis is documented.

FAQ

Is M54.12 a billable code?

Yes. M54.12 is valid for HIPAA-covered transactions at the highest level of specificity within the M54.1 subcategory. The parent M54.1 is non-billable. Only the region-specific children are reportable.

When is M54.12 the right code instead of the M50.1- codes?

M54.12 applies when cervical radiculopathy is documented without a structural cause, or when the cause has not been established. Once a cervical disc disorder is documented as the cause, the M50.1- code for the documented level applies instead.

Can M54.12 and a cervical disc code be reported together?

M54.12 and a cervical disc code are not reported together for the same radiculopathy. The Excludes1 note at the M54.1 subcategory level bars M54.12 when a cervical disc disorder is the documented cause. That chart is coded to an M50.1- code alone. Guideline I.A.12.a allows both codes when the conditions are unrelated.

How is M54.12 different from M54.2?

M54.12 requires documented nerve root involvement, shown by radicular arm pain, paresthesia or weakness. M54.2, cervicalgia, records localized neck pain without radicular features.

Does M54.12 carry risk adjustment weight?

No. M54.12 carries no HCC designation in CMS-HCC v28 or v24. Reporting it does not raise a beneficiary's risk score and does not generate HCC credit for a Medicare Advantage plan.

Why does M54.12 group to MDC 01 rather than MDC 08?

Appendix B of the FY2027 MS-DRG v44 Definitions Manual assigns M54.12 to MDC 01, Diseases and Disorders of the Nervous System. The assignment is code specific: M54.16, lumbar radiculopathy, groups to MS-DRG 551 or 552 in MDC 08. An inpatient stay principally coded to M54.12 groups to MS-DRG 073 with MCC or MS-DRG 074 without MCC, both under MDC 01.

How is M54.12 used in the inpatient setting compared with the outpatient setting?

In the outpatient setting M54.12 is reported in neurology, orthopedic spine and pain management encounters for evaluation and treatment such as physical therapy, cervical traction and epidural steroid injection. In the inpatient setting it may be the principal diagnosis for acute severe cervical radiculopathy requiring intravenous pain management, or a secondary code alongside cervical spine surgery.

Did anything change for M54.12 in FY2027?

M54.12 is unchanged in the FY2027 update, effective 1 October 2026. No FY2026 changes were identified for M54.12 or for the M54.1 subcategory either.

Related codes

Codes in the same family as M54.12. Only codes with a published page render as links.

Sibling codes in the M54.1 family

M54.11: Radiculopathy, occipito-atlanto-axial 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.
M54.10: Radiculopathy, site unspecified.

Additional codes to consider

Codes outside the M54.1 family considered alongside M54.12.

Consider instead

M50.12-: Cervical disc disorder with radiculopathy, mid-cervical region, when a cervical disc disorder is the documented cause.
M50.10: Cervical disc disorder with radiculopathy, unspecified cervical region, when the disc level is not documented.
M47.22: Other spondylosis with radiculopathy, cervical region, when cervical spondylosis is the documented cause.
M54.11: Radiculopathy, occipito-atlanto-axial region, when the documented level is C0 to C2.
M54.13: Radiculopathy, cervicothoracic region, when the documented level is the C7 to T1 junction.
M54.10: Radiculopathy, site unspecified, when no spinal region is documented.
M54.2: Cervicalgia, when neck pain is documented without radicular features.
M79.2: Neuralgia and neuritis, unspecified, when neuralgia is documented without a spinal cause.
G54.2: Cervical root disorders, not elsewhere classified, when a cervical root disorder is specified beyond the scope of M54.12.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software