Does M48.52XS require prior authorization?

No, M48.52XS 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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`M48.52XS`, Collapsed vertebra, not elsewhere classified, cervical region, sequela of fracture

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

A valid, written, physician-signed and dated plan of treatment must be established prior to provision of physical therapy and must outline type, amount, frequency, duration, functional diagnosis deficits, and anticipated short- and long-term goals.
Services must be ordered by a physician and the order must be documented in the medical record.
Treatment notes must be completed per visit, be legible, objectively document findings (e.g., numeric pain scores), relate to established goals, reflect all services billed, and use consistent symbols/acronyms or provide a legend.

Key Coverage Criteria

Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
Beneficiary is under the care of a physician.
Beneficiary is receiving services under a plan of care that is established and periodically reviewed by a physician.
Beneficiary needs skilled nursing care on an intermittent basis, or physical therapy, or speech-language pathology, or has a continued need for occupational therapy.
Physical therapy services ordered by a physician and provided by a qualified physical therapist or under the general supervision of a qualified physical therapist are covered when reasonable and necessary to treat illness/injury or to restore or maintain function.
Physical therapy services provided as a result of a valid written, physician-signed and dated plan of treatment established prior to provision that specifies type, amount, frequency, duration, functional diagnosis deficits, and short- and long-term goals are covered.

20 Active Policies

CGS-J15-L39741, Cervical Fusion

J15

CGS-J18-L39741, Cervical Fusion

J18

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

WPS-J5-L39788, Cervical Fusion

A59664, Billing and Coding: Cervical Fusion

NGS-J6-L39770, Cervical Fusion

A58893, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A59632, Billing and Coding: Cervical Fusion

WPS-J8-L39788, Cervical Fusion

A59764, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A59674, Billing and Coding: Cervical Fusion

FIRST_COAST-L39799, Cervical Fusion

NOVITAS-JH-L39793, Cervical Fusion

NGS-JK-L39770, Cervical Fusion

A59766, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

NOVITAS-JL-L39793, Cervical Fusion

A59668, Billing and Coding: Cervical Fusion

A59374, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A57311, Billing and Coding: Physical Therapy - Home Health

A59608, Billing and Coding: Cervical Fusion

`M48.52XS`, Collapsed vertebra, not elsewhere classified, cervical region, sequela of fracture

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M48.52XS, Collapsed vertebra, not elsewhere classified, cervical region, sequela of fracture

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M48.52XS`, Collapsed vertebra, not elsewhere classified, cervical region, sequela of fracture