Does G32.0 require prior authorization?

No, G32.0 does not require prior authorization (high confidence). Covered without prior authorization.

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`G32.0`, Subacute combined degeneration of spinal cord in diseases classified elsewhere

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

When NCSs and NEMG are performed on the same day for the same patient they must be reported on the same claim.
When billing non-covered services/tests report unlisted neurological CPT 95999 and provide a description of the service/test in block 80 (Part A) or box 19 (Part B) or electronic equivalent; failure to include this information will result in Part A claims being returned and Part B claims rejected.
All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and include the legible signature of the responsible physician or non-physician practitioner.

Key Coverage Criteria

Nerve conduction studies (NCS) without needle electromyography (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the diagnosis codes G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53 is reported.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when diagnosis code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when diagnosis code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
Neurophysiology Evoked Potentials (NEPs) — including Somatosensory Evoked Potentials (SEPs), Brainstem Auditory Evoked Potentials (BAEPs/BAERs), and Visual Evoked Potentials (VEPs/VERs) — are covered when determined to be reasonable and necessary in accordance with LCD L34975.
Nerve conduction studies (NCS) without needle EMG (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following ICD-10-CM codes is reported: G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when ICD-10-CM code I89.0 is reported in addition to the primary diagnosis.

20 Active Policies

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

WPS-J8-L34594, Nerve Conduction Studies and Electromyography

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

A57123, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L33967, Vitamin B<sub>12</sub> Injections

NOVITAS-JH-L35081, Nerve Conduction Studies and Electromyography

NOVITAS-JH-L34975, Neurophysiology Evoked Potentials (NEPs)

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

NOVITAS-JL-L34975, Neurophysiology Evoked Potentials (NEPs)

NOVITAS-JL-L35081, Nerve Conduction Studies and Electromyography

A56773, Billing and Coding: Neurophysiology Evoked Potentials (NEPs)

A54095, Billing and Coding: Nerve Conduction Studies and Electromyography

A57755, Billing and Coding: Vitamin B12 Injections

AMBETTER-CP.MP.99, Wheelchair Seating

CIGNA-CPG129, Electrodiagnostic Testing (EMG/NCV)

`G32.0`, Subacute combined degeneration of spinal cord in diseases classified elsewhere

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G32.0, Subacute combined degeneration of spinal cord in diseases classified elsewhere

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G32.0`, Subacute combined degeneration of spinal cord in diseases classified elsewhere