Does M47.28 require prior authorization?

No, M47.28 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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`M47.28`, Other spondylosis with radiculopathy, sacral and sacrococcygeal 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

All documentation must be maintained in the patient medical record, be legible, include patient identification and the identity of the physician or non-physician practitioner responsible for care, and be available to the contractor upon request.
Medical record documentation maintained by the ordering/treating physician must indicate the medical necessity and clinical indication(s) that led to ordering the drug test and support the selected diagnosis and CPT/HCPCS code(s).
All tests must be ordered in writing by the treating provider and the order must specify all drugs/drug classes to be tested; the physician’s order must include the clinical indication/medical necessity.

Key Coverage Criteria

Urine, blood, or oral fluid specimens may be used for drug testing, with urine preferred for broad screening of common drugs.
Medicare Part B will pay for drug screening services when all coverage criteria, limitations, and medical necessity requirements of LCD DL34645 are met.
Claims for drug screening services are payable under Medicare Part B only in these places of service: office (11), urgent care (20), independent clinic (49), federally qualified health center — freestanding (50), rural health clinic — freestanding (72), and independent laboratory (81).
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).

20 Active Policies

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J18-L36029, Urine Drug Testing

J18

CGS-J18-L35906, Somatosensory Testing

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

A57595, Billing and Coding: Pelvic Floor Dysfunction: Anorectal Manometry and EMG

WPS-J5-L34645, Urine Drug Testing

A57597, Billing and Coding: Somatosensory Testing

A56915, Billing and Coding: Urine Drug Testing

WPS-J5-L35486, Pelvic Floor Dysfunction: Anorectal Manometry and EMG

WPS-J5-L34624, Somatosensory Testing

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

NGS-J6-L39611, Urine Drug Testing

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A58893, 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

A59416, Billing and Coding: Urine Drug Testing

`M47.28`, Other spondylosis with radiculopathy, sacral and sacrococcygeal region

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M47.28, Other spondylosis with radiculopathy, sacral and sacrococcygeal region

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M47.28`, Other spondylosis with radiculopathy, sacral and sacrococcygeal region