Does M46.1 require prior authorization?

No, M46.1 does not require prior authorization (low confidence). No active coverage policies found for this code.

`M46.1`, Sacroiliitis, not elsewhere classified

ICD-10-CM

No Prior Auth Required

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

The patient's medical record must contain documentation that fully supports medical necessity for services included within the related LCD, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Medical record documentation must be available to Medicare upon request.
All documentation must be maintained in the patient's medical record and be made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification information such as complete name and dates of service.

Minimally-invasive surgical fusion of the sacroiliac (SI) joint is covered when the patient's medical record documents medical necessity per the related Local Coverage Determination (LCD), including relevant history, physical exam, and diagnostic test results supporting the procedure.
Coverage for percutaneous minimally invasive fusion/stabilization of the sacroiliac joint is determined by the related Local Coverage Determination L36000 and only covered when that LCD's clinical indications are met.
Coverage for amniotic and placental-derived product injections/applications for musculoskeletal, non-wound indications is determined by Local Coverage Determination L39139; consult LCD L39139 for specific clinical indications and thresholds.
Diagnostic sacroiliac joint injection(s) (CPT 27096 and/or 64451) to confirm sacroiliac joint–mediated pain; may be performed unilateral or bilateral.
Therapeutic sacroiliac joint injection(s) (CPT 27096 and/or 64451) for treatment of sacroiliac joint pain; may be performed unilateral or bilateral.
Injections of the nerves innervating the sacroiliac joint should be performed/reported with CPT 64451 (includes imaging guidance).

CGS-J15-L39383, Sacroiliac Joint Injections and Procedures

J15

CGS-J15-L39802, Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J18-L39383, Sacroiliac Joint Injections and Procedures

J18

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