Does M48.20 require prior authorization?

No, M48.20 does not require prior authorization (low confidence). No active coverage policies found for this code.

`M48.20`, Kissing spine, site unspecified

ICD-10-CM

No Prior Auth Required

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

Medical records must clearly document medical necessity for each test and include the reason for referral and a clear diagnostic impression.
Data gathered during NCS should be available showing actual numeric results (latency, amplitude, etc.), preferably in tabular format.
In cases of review, provide a hard copy of waveforms or a complete written report with interpretation upon request.
Normal findings and abnormalities must document muscles tested, presence and type of spontaneous activity, characteristics of voluntary motor unit potentials, and interpretation.

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.
Spinal cord stimulation (SCS) is covered for chronic pain when the clinical record documents the diagnosis and prior conservative therapies tried before the decision to use SCS.
Temporary SCS trials (CPT 63650) are covered when performed in an office, ambulatory surgical center (ASC), outpatient hospital, or hospital with appropriate clinical documentation.
One permanent SCS implant (CPT 63655) is covered per patient when performed in an ASC, outpatient hospital, or hospital and supported by medical necessity documentation.
No specific clinical indications are provided in this billing and coding article; coverage criteria for amniotic and placental-derived product injections/applications for musculoskeletal non-wound indications are described in Local Coverage Determination L39116.

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

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

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