Does M50.120 require prior authorization?

No, M50.120 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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`M50.120`, Mid-cervical disc disorder, unspecified level

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

The article provides billing and coding guidance and references LCD L39116; required documentation (e.g., medical records, prior authorization, specific forms) is not specified here and must be obtained from LCD L39116.
Billing, coding, and documentation requirements (e.g., required medical record elements, coding guidance, prior authorization if applicable) are specified in LCD L39139 and accompanying billing guidance; review LCD L39139 for the exact documentation required for claims.
This billing and coding article references Local Coverage Determination LCD L39624 for coverage and documentation requirements for amniotic and placental-derived product injections/applications for musculoskeletal (non-wound) indications; the LCD text was not provided so specific documentation requirements cannot be extracted.

Key Coverage Criteria

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.
Coverage for amniotic and placental-derived product injections/applications for musculoskeletal, non-wound indications is determined by Local Coverage Determination L39139; consult LCD L39139 for specific clinical indications and thresholds.
Cervical fusion and related procedures are covered when they meet the reasonable and necessary clinical criteria and frequency limits specified in Local Coverage Determination (LCD) L39738.
Cervical fusion and related cervical spine fusion procedures are covered when they meet the reasonable and necessary clinical and frequency criteria specified in Local Coverage Determination (LCD) L39758.
Cervical fusion and related cervical spine fusion procedures are the only procedures covered under this policy; other joint or non-cervical spinal procedures (e.g., facet, sacroiliitis, epidural) are not covered by this policy.
Coverage for a cervical fusion procedure is allowed only when the service meets the reasonable and necessary clinical criteria and frequency limitations specified in the applicable draft Local Coverage Determination (LCD) Cervical Fusion.

20 Active Policies

CGS-J15-L39741, Cervical Fusion

J15

CGS-J18-L39741, Cervical Fusion

J18

WPS-J5-L39788, Cervical Fusion

A59664, Billing and Coding: Cervical Fusion

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

A59632, 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

WPS-J8-L39788, Cervical Fusion

FIRST_COAST-L39799, 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

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

A59608, Billing and Coding: Cervical Fusion

A59624, Billing and Coding: Cervical Fusion

A58865, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

`M50.120`, Mid-cervical disc disorder, unspecified level

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M50.120, Mid-cervical disc disorder, unspecified level

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M50.120`, Mid-cervical disc disorder, unspecified level