Does M46.43 require prior authorization?

No, M46.43 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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`M46.43`, Discitis, unspecified, cervicothoracic 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.

The patient's medical record must contain documentation that fully supports medical necessity per the related LCD, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

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, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J18

CGS-J18-L34056, Urodynamics

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

CGS-J18-L39741, Cervical Fusion

J18

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

A59434, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A59664, Billing and Coding: Cervical Fusion

WPS-J5-L39788, Cervical Fusion

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L39770, Cervical Fusion

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A59632, Billing and Coding: Cervical Fusion

A58893, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

NGS-J6-L33576, Urodynamics

A57455, Billing and Coding: Urodynamics

`M46.43`, Discitis, unspecified, cervicothoracic region

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M46.43, Discitis, unspecified, cervicothoracic region

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M46.43`, Discitis, unspecified, cervicothoracic region