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ICD-10-CM M50.13, Cervical disc disorder with radiculopathy, cervicothoracic region | No Prior Auth

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`M50.13`, Cervical disc disorder with radiculopathy, cervicothoracic region

ICD-10-CM

Prior Authorization

No Prior Auth Required

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

Documentation Required

A clinical history from the referral source indicating the need for testing must be available in the medical record and retrievable for review.
If an E/M service is billed as separate and identifiable, medical record must document medical necessity and the E/M CPT code must be billed with modifier 25.
Nerve conduction study reports must include numerical data (amplitude, latency, velocity) and F-wave descriptions must reference corresponding motor conduction data.

Blink reflex (CPT 95933) reports should include bilateral recordings with ipsilateral and contralateral stimulation and note presence or absence of R1 and R2 components.

Neuromuscular junction studies (CPT 95937) reports must document stimulation rate and any significant incremental or decremental responses and may be reported separately from motor/sensory NCS of the same nerves.

When testing exceeds the reasonable maximum numbers listed in the guidance table, the provider must supply supplementary documentation justifying the additional tests; documentation must also justify testing an asymptomatic contralateral limb for normative values.

Key Coverage Criteria

Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.
EMG and/or nerve conduction studies are indicated for evaluation of suspected radiculopathy.
EMG and/or nerve conduction studies are indicated for evaluation of suspected mononeuropathy (single-nerve entrapment or injury).
EMG and/or nerve conduction studies are indicated for evaluation of suspected polyneuropathy or mononeuropathy multiplex.
EMG is indicated for evaluation of suspected myopathy.
EMG and nerve conduction studies are indicated for evaluation of suspected motor neuropathies (e.g., amyotrophic lateral sclerosis).

20 Active Policies

CGS-J15-L39015, Epidural Steroid Injections for Pain Management

J15

CGS-J15-L39741, Cervical Fusion

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L39015, Epidural Steroid Injections for Pain Management

J18

CGS-J18-L39741, Cervical Fusion

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

J5

A58777, Billing and Coding: Epidural Steroid Injections for Pain Management

J5

WPS-J5-L39788, Cervical Fusion

J5

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

J5

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

J5

A59664, Billing and Coding: Cervical Fusion

J5

WPS-J5-L39054, Epidural Steroid Injections for Pain Management

J5

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

J6

A58745, Billing and Coding: Epidural Steroid Injections for Pain Management

J6

NGS-J6-L39770, Cervical Fusion

J6

NGS-J6-L39036, Epidural Steroid Injections for Pain Management

J6

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

J6

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

J6

A59632, Billing and Coding: Cervical Fusion

J6

Related Codes

M50.122(20 policies)M54.13(20 policies)M47.23(20 policies)M50.121(20 policies)M50.123(20 policies)M54.12(20 policies)M47.22(20 policies)M96.1(20 policies)

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