Does M17.5 require prior authorization?

No, M17.5 does not require prior authorization (low confidence). No active coverage policies found for this code.

`M17.5`, Other unilateral secondary osteoarthritis of knee

ICD-10-CM

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Medicare contractors may require operative notes, reports of standing x-rays, and/or arthroscopy results to define the patient’s knee condition when adjudicating coverage.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
A valid ICD-10-CM diagnosis code that best describes the patient's condition must be submitted on the claim; claims without a valid ICD-10-CM code will be returned as incomplete under Section 1833(e).
An Advance Beneficiary Notice of Noncoverage (ABN) may be used for outpatient services likely to be non-covered; follow CMS Claims Processing Manual Chapter 30 guidance when issuing ABNs.

Arthroscopic lavage or arthroscopic debridement for osteoarthritic knee in patients WITHOUT severe osteoarthritis who present with mechanical symptoms (eg, locking, snapping, popping), abnormal limb/knee alignment, or less severe/early degenerative arthritis may be considered for coverage at the discretion of the Medicare contractor.
Intra-articular hyaluronan injections are covered for pain associated with osteoarthritis of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy and simple analgesics.
Intra-articular hyaluronan injections may be used as a therapeutic option for osteoarthritis of the shoulder.
Bariatric surgery for treatment of co-morbid conditions related to morbid obesity is payable when billed in accordance with CMS Pub 100-03 Medicare National Coverage Determinations Manual, Chapter 1 Part 2 Section 100.1.
Additional diagnoses listed in this local coverage article for Part A procedure codes and the article's listed CPT codes are covered for bariatric surgery to treat co-morbid conditions related to morbid obesity.
Intraarticular hyaluronan is covered for treatment of symptomatic osteoarthritis of the knee in patients who have failed to respond adequately for at least 3 months to simple analgesics and conservative nonpharmacologic therapy (exercise/physical therapy, weight loss if appropriate, use of assistive devices).

CGS-J15-L40232, Total Joint Arthroplasty

J15

CGS-J18-L40232, Total Joint Arthroplasty

J18

WPS-J5-L39529, Intraarticular Knee Injections of Hyaluronan

A59811, Billing and Coding: Total Joint Arthroplasty

A56157, Billing and Coding: Intraarticular Knee Injections of Hyaluronan

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