Does M47.896 require prior authorization?

No, M47.896 does not require prior authorization (low confidence). No active coverage policies found for this code.

`M47.896`, Other spondylosis, lumbar region

ICD-10-CM

No Prior Auth Required

No active coverage policies found for this code (low confidence)

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.

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).
Somatosensory testing is covered when medically reasonable and necessary and documented in the patient's medical record (relevant history, physical exam, and pertinent diagnostic test results).
Testing and interpretation are covered when ordered and/or furnished by qualified personnel who have documented training and experience in evoked potentials and electrodiagnostics per CMS guidance (accredited residency/fellowship, national certification, or accredited post-graduate training/AMA-AOA Category 1 CME).
The technical component may be furnished by a physical therapist with ABPTS certification without physician supervision, or by a certified technician under supervision consistent with the MPFSDB supervision level assigned to the CPT code (e.g., Level 21 for CPT 95925, 92526, 95927, 95938).

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J15-L35906, Somatosensory Testing

J15

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

J15

CGS-J18-L35906, Somatosensory Testing

J18

CGS-J18-L38773

Ask Backwork about documentation requirements, denial risks, or coverage in your state.