Does M46.42 require prior authorization?

No, M46.42 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`M46.42`, Discitis, unspecified, cervical region

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and the reason(s) the urodynamic service was performed.
For diagnostic urodynamic tests, report the test result if known; if results are not available at time of claim, report the symptoms that prompted the test.
When a penile pressure cuff is used during a voiding pressure study, report CPT code 55899 and note the non-invasive urodynamic study in the narrative portion of the claim.
When a referring/ordering physician is required, the referring/ordering physician's name and NPI must be reported on the claim.

Key Coverage Criteria

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.
EMG is indicated for evaluation of suspected myopathy.

20 Active Policies

CGS-J15-L39521, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J15

CGS-J15-L39741, Cervical Fusion

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L34056, Urodynamics

J15

CGS-J18-L39521

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M46.42, Discitis, unspecified, cervical region