Does M50.90 require prior authorization?

No, M50.90 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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`M50.90`, Cervical disc disorder, unspecified, unspecified cervical region

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

Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and the reason(s) the urodynamic service was performed.
For diagnostic urodynamic tests, report the test result if known; if results are not available at time of claim, report the symptoms that prompted the test.
When a penile pressure cuff is used during a voiding pressure study, report CPT code 55899 and note the non-invasive urodynamic study in the narrative portion of the claim.

The patient's medical record must contain documentation that fully supports medical necessity per the related LCD, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Key Coverage Criteria

Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
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.
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.
Coverage applies when the amniotic or placental-derived product injection/application meets the reasonable and necessary requirements of Local Coverage Determination L39877.

14 Active Policies

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

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

NGS-J6-L33576, Urodynamics

A57455, Billing and Coding: Urodynamics

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

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

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

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

NGS-JK-L33576, Urodynamics

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

AETNA-CPB-0093, Open Air, Low Field Strength, and Positional Magnetic Resonance Imaging (MRI) Units

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

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

CIGNA-0509, Intraoperative Monitoring

`M50.90`, Cervical disc disorder, unspecified, unspecified cervical region

Prior Authorization

Documentation Required

Key Coverage Criteria

14 Active Policies

Related Codes

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M50.90, Cervical disc disorder, unspecified, unspecified cervical region

Prior Authorization

Documentation Required

Key Coverage Criteria

14 Active Policies

Related Codes

Have a follow-up question?

`M50.90`, Cervical disc disorder, unspecified, unspecified cervical region