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Medicare acceptable Diagnosis
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Patient Name
Date
THORACIC
CERVICAL
ICD-10 DIAGNOSIS CHART
LUMBAR
Seg Dysfx Head M99.00
Seg Dysfx Neck M99.01
Medicare Cat 1 (1-6 tx)
Spondylosis (back pain OA) w/ Rad
-OA C0-1-2 M47.21
-Cervical M47.22
Spondylosis (Age related OA) w/o Rad
-OA C0-1-2 M47.811
-Cervical M47.812
DISH
-C0-1-2 M48.11
-Cervical M48.12
Cervicalgia M54.2
Headache cervicogenic (gen) R51
Tension headache G44.209
Episodic Tension Headache G44.219
Chronic tension Headache G44.229
Vascular Headache G44.1
Category 2 Medicare DX (7-12 tx)
Neck Sprain Lig.’s S13.4XXA
Neck muscle/tendon/ S16.1XXA
Neck Joints & other S13.8XXA
Brachial thoracic outlet synd. G54.0
Cervical Radiculopathy G54.2
Joint Pain M25.50
Spondylolisthesis C0-2 M43.11
Spondylolisthesis C3-6 M43.12
Fusion C0-2 M43.21
Fusion C3-6 M43.22
Spinal Tendinitis C0-2 M46.01
Spinal Tendinitis C3-6 M46.02
Stenosis C0-2 M48.01
Stenosis C3-6 M48.02
IVD Disorder w/ Rad C0-2 M50.11
IVD Disorder w/ Rad C3-6 M50.12
Other IVD C0-1 M50.81
Other IVD C3-6 M50.82
Cervicocranial Syndrome M53.0
Cervicobrachial Syndrome M53.1
Radiculopathy C0-2 M54.11
Radiculopathy C3-6 M54.12
Muscle Spasms of Back M62.830
Myalgia M79.1
Fibromyalgia M79.7
Stenosis of Neural Canal
-Subluxation Neck M99.21
-Osseous Neck M99.31
-Connective Tissue Neck M99.41
-IVD Neck M99.51
Intervertebral Foramina Stenosis
-Osseous & Subluxation CS M99.61
-Connective Tissue & Disc CS M99.71
Category 3 Medicare DX (12-24 tx)
IVD Disorder W/O C0-2 M50.21
IVD Disorder W/O C3-6 M50.22
Disc Degn. C0-2 M50.31
Disc Degn. C3-6 M50.32
Disc Degn. C7-T1 M50.33
Postlaminectomy synd M96.1
Traumatic Spondylopathy (disease)
-C0-2 M48.31
-C3-6 M48.32
Seg. Dysfx. M99.02
Medicare Cat 1 (1-6 tx)
Spondylosis (back pain OA) w/ Rad
-Thoracic M47.24
-Cervcothoracic M47.23
Spondylosis (Age related OA) w/o Rad
-Thoracic M47.814
-Cervcothoracic M47.813
DISH
-Cervcothoracic M48.13
-Thoracic M48.14
-Thoracic spine pain M54.6
Category 2 Medicare DX (7-12 tx)
Thoracic Sprain S23.3XXA
Thoracic other Sp/St S23.8XXA
Thoracic Radiculopathy G54.3
Joint Pain M25.50
Spondylolisthesis C7-T1 M43.13
Spondylolisthesis T2-T11 M43.14
Fusion C7-T1 M43.23
Fusion T2-T11 M43.24
Spinal Tendinitis C7-T1 M46.03
Spinal Tendinitis T2-T11 M46.04
Stenosis C7-T1 M48.03
Stenosis T2-T11 M48.04
IVD Disorder w/ RadC7-T1 M51.13
IVD Disorder w/ RadT2-11 M51.14
Other IVD C7-T1 M50.83
Other IVD T2-11 M51.84
Radiculopathy C7-T1 M54.13
Radiculopathy T2-12 M54.14
Myalgia M79.1
Fibromyalgia M79.7
Stenosis of Neural Canal
-Subluxation Thoracic M99.22
-Osseous Thoracic M99.32
-Connective Tissue Thoracic M99.42
--IVD Thoracic M99.52
Intervertebral Foramina Stenosis
-Osseous & Subluxation TS M99.62
-Connective Tissue & Disc TS M99.72
Category 3 Medicare DX (12-24 tx)
IVD Disorder W/O C7-T1 M50.23
IVD Disorder W/O T2-11 M51.24
Disc Degn. T2-11 M51.34
Disc Degn. T12-L1 M51.35
Postlaminectomy synd M96.1
Traumatic Spondylopathy (disease)
-C7-T1 M48.33
-T1-T11 M48.34
Pelvis Sacrum Coccyx
Seg Dysfx Sacrum M99.04
Seg Dysfx hip, pelvis M99.05
Medicare Cat 1 (1-6 tx)
Spondylosis (back pain OA) w/ Rad
Lumbosacral M47.27
Sacral-Coccyx M47.28
Spondylosis (Age related OA) w/o Rad
Lumbosacral M47.27
Sacral-Coccyx M47.818
DISH
Lumbosacral M48.17
Sacral & Sacrococcygeal M48.18
Category 2 Medicare DX (7-12 tx)
Sacroiliac Sprain S33.6XXA
Sacroiliac Sp/St other S33.8XXA
Joint Pain M25.50
Spondylolisthesis L5-S1 M43.17
Spondylolisthesis Sac/Coccyx M43.18
Fusion L5-S1 M43.27
Fusion Sac-Coccyx M43.28
Spinal Tendinitis L5-S1 M46.07
Spinal Tendinitis Sac-Cocyx M46.08
Stenosis lumbosacral M48.07 Myalgia M79.1
Fibromyalgia M79.7
IVD Disorder w/Rad L5-S1 M51.17
Other IVD L5-S1 M50.87
Sacrococcygeal Instability M53.2X8
Radiculopathy L5-S1 M54.17
Category 3 Medicare DX (12-24 tx)
IVD Disorder W/O L5-S1 M51.27
Disc Degn. L5-S1 M51.37
Traumatic Spondylopathy (disease)
-L5-S1 M48.37
-Sacrococcygeal M48.38
Seg. Dysfx* M99.03
Medicare Cat 1 (1-6 tx)
Spondylosis (back pain OA) w/ Rad
Lumbar M47.26
Thoracolumbar M47.25
Spondylosis (Age related OA) w/o Rad
Thoracolumbar M47.815
Lumbar M47.16 DISH
Thoracolumbar M48.15
Lumbar M48.16
Low Back Pain M54.5
Category 2 Medicare DX (7-12tx)
Lumbar Sprain S33.5XXA
Lumbar other Sp/St S33.8XXA
Lumbosacral plx dis vasc G54.1
Lumbosacral Radiculopathy G54.4
Joint Pain M25.50
Spondylolisthesis T12-L1 M43.15
Spondylolisthesis L2-L4 M43.16
Fusion T12-L1 M43.25
Fusion L2-L4 M43.26
Spinal Tendinitis T12-L1 M46.05
Spinal Tendinitis L2-L4 M46.06
Stenosis T12-L1 M48.05
Stenosis L2-L4 M48.06 IVD Disordr w/RadT12-L1 M51.15
IVD Disordr w/Rad L2-L4 M51.16 Other IVD T12-L1 M50.85
Other IVD C7-T1 M50.86
Lumbosacral Instability M53.2X7
Radiculopathy T12-L1 M54.15
Radiculopathy L2-4 M54.16
Myalgia M79.1
Fibromyalgia M79.7
Stenosis of Neural Canal
-Subluxation Lumbar M99.23
-Osseous Lumbar M99.33
-Connective Tissue Lumbar M99.43
-IVD Lumbar M99.53
Intervertebral Foramina Stenosis
-Osseous & Subluxation LS M99.63
-Connective Tissue & Disc LS M99.73
Category 3 Medicare DX (12-24 tx)
IVD Disorder W/O T12-L1 M51.25 IVD Disorder W/O L2-L4 M51.26
Disc Degn. L2-L4 M51.36
Sciatica Right M54.31
Sciatica Left M54.32
Lumbago w/ Sciatica Right M54.41
Lumbago w/ Sciatica Left M54.42
Postlaminectomy synd M96.1
Traumatic Spondylopathy (disease)
-T12-L1 M48.35
-L2-L4 M48.36
Free conversion website
To Adjust Extremities use Myositis and Segmental Dysfunction DX
Shoulder R/L M60.811/2 Thigh R/L M60.851/2
Upper Arm R/L M60.821/2 Lower leg M60.861/2
Forearm R/L M60.831/2 Ankle M60.871/2
Hand R/L M60.841/2
Medicare Acceptable Diagnosis
Category 1(1-6 visits) Category 2 (6-12 visits) Category 3 (12-24 visits)
Must include segmental dysfunction and lead w/ highest category DX 1st
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