Does M47.029 require prior authorization?

No, M47.029 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

Backwork Sign up free

`M47.029`, Vertebral artery compression syndromes, site unspecified

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

When billing CPT 95905 for carpal tunnel, the diagnosis code must be G56.01 or G56.02.
Data gathered during NCS should be available to support the claim, although it is not necessary to include documentation with every claim submission.
Providers are expected to use CPT 95870 for sampling muscles other than paraspinals associated with tested extremities; CPT 95870 should not be billed for paraspinal sampling when extremity EMG codes 95860, 95861, 95863, or 95864 are also billed.

Key Coverage Criteria

Automated nerve conduction testing using the NC-stat (CPT 95905) is allowed only when there is a high pre-test or prior probability of carpal tunnel syndrome and the claim uses diagnosis code G56.01 or G56.02; allowed one service per arm.
If authorized by state law, physical therapists (PTs) are allowed to perform the technical and professional components of nerve conduction studies represented by CPT codes 95907-95913 consistent with a 7A supervision designation (effective 01/01/2013).
If authorized by state law, the technical component of neuromuscular junction testing CPT 95937 (TC) with supervision designation 7A is allowable for PTs consistent with the 7A description (effective 01/01/2013).
Needle electromyography CPT codes 95860-95872 and 95885-95887 have a 6A designation for the technical portion; PTs who are ABPTS-certified as qualified electrophysiologic clinical specialists and are authorized by state law may perform the technical and professional components according to the 6A description.
Electrodiagnostic nerve conduction studies and electromyography that provide real-time response parameters (amplitude, latency, configuration, conduction velocity) are acceptable for Medicare payment and should be used for provider interpretation.
Compounded medications for use in implantable infusion pumps may be covered by Medicare when their use meets all other criteria for services provided incident to a physician's service.

18 Active Policies

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

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

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

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A59764, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

FIRST_COAST-L33958, Somatosensory Testing

NOVITAS-JH-L35003, Intraoperative Neurophysiological Testing

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

NOVITAS-JL-L35003, Intraoperative Neurophysiological Testing

A56722, Billing and Coding: Intraoperative Neurophysiological Testing

A59766, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A57791, Billing and Coding: Spinal Cord Stimulators for Chronic Pain

A58865, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

A59374, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A56695, Billing and Coding: Implantable Infusion Pump

A56619, Billing and Coding: Nerve Conduction Studies and Electromyography

A57540, Billing and Coding: Somatosensory Testing

`M47.029`, Vertebral artery compression syndromes, site unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

18 Active Policies

Related Codes

Have a follow-up question?

M47.029, Vertebral artery compression syndromes, site unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

18 Active Policies

Related Codes

Have a follow-up question?

`M47.029`, Vertebral artery compression syndromes, site unspecified