Does D33.4 require prior authorization?

No, D33.4 does not require prior authorization (high confidence). Covered without prior authorization.

`D33.4`, Benign neoplasm of spinal cord

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The patient's medical record must contain documentation that fully supports medical necessity for services included in the related LCD, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Include a treatment prescription that defines treatment goals and specific dose-volume parameters for the target and nearby critical structures, and details of beam delivery such as method of beam modulation, field arrangement, and expected positional and range uncertainties.
Include a physician-signed treatment plan that meets the prescribed dose-volume parameters for the clinical target volume (CTV) and surrounding organs at risk (OARs) accounting for expected uncertainties.
Describe the target setup verification methodology, including patient positioning, immobilization, and use of image guidance.

Proton beam therapy is covered when the service meets the medical necessity criteria specified in the related Local Coverage Determination (LCD) and those criteria are documented in the medical record.
Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.
EMG and/or nerve conduction studies are indicated for evaluation of suspected radiculopathy.
EMG and/or nerve conduction studies are indicated for evaluation of suspected mononeuropathy (single-nerve entrapment or injury).
EMG and/or nerve conduction studies are indicated for evaluation of suspected polyneuropathy or mononeuropathy multiplex.

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L36658, Proton Beam Therapy

J15

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J15-L34056, Urodynamics

J15

CGS-J18-L36658, Proton Beam Therapy

Ask Backwork about documentation requirements, denial risks, or coverage in your state.