Does M47.892 require prior authorization?

No, M47.892 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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`M47.892`, Other spondylosis, 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

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.
If the performing provider is different from the ordering/referring physician, the performing provider must maintain hard copy documentation of lab results and copies of the ordering physician’s order for the drug test.

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).
NC-stat testing (CPT 95905) is allowed when the beneficiary has a high pre-test or prior probability of Carpal Tunnel Syndrome (CTS), limited to one service per arm.
Use CPT 95870 for sampling muscles other than the paraspinals associated with the extremities that have been tested.
Facet joint interventions (diagnostic nerve block, therapeutic intraarticular injection, medial branch block, or medial branch radiofrequency ablation/neurotomy) for cervical/thoracic or lumbar/sacral regions are covered when reasonable and necessary per the applicable Local Coverage Determination (LCD).

20 Active Policies

CGS-J15-L38773, Facet Joint Interventions for Pain Management

J15

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J18-L39857, Botulinum Toxin Injections

J18

CGS-J18-L38773

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M47.892, Other spondylosis, cervical region