Does M48.35 require prior authorization?

No, M48.35 does not require prior authorization (low confidence). No active coverage policies found for this code.

`M48.35`, Traumatic spondylopathy, thoracolumbar region

ICD-10-CM

No Prior Auth Required

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

A legible medical record must document the condition, clinical findings, relevant prior treatment, and clearly justify the necessity and reasonableness of the lumbar MRI.
The documentation must clearly support the ICD-10-CM code(s) reported on the claim.
An attending or treating physician's order, properly signed and dated, is required for each lumbar MRI test.
Radiologists and ordering physicians must include sufficient clinical information in the MRI report to justify necessity; the MRI report or clinical record must document clinical findings and relevant prior treatment.

Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.
NC-stat® System (alone) is allowed when the beneficiary has a high pre-test probability or prior probability of Carpal Tunnel Syndrome, using CPT 95905.
Allow one NC‑stat® System service per arm (i.e., maximum one service billed with CPT 95905 per arm) for the indicated Carpal Tunnel Syndrome diagnosis.
Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

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