Does M51.360 require prior authorization?

No, M51.360 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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`M51.360`, Other intervertebral disc degeneration, lumbar region with discogenic back pain only

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

Claims must be submitted in accordance with CMS Pub 100-04 Medicare Claims Processing Manual, Chapter 32 Section 150 (Billing Requirements for Bariatric Surgery for Morbid Obesity), including use of the procedure and diagnosis codes listed there and in this local article.
Coverage for Type II diabetes mellitus complication diagnosis codes is based on the Internet Only Manual (IOM); include documentation and citations required by IOM when billing these diagnoses.
Bariatric surgery claims must reference the applicable national coverage determination (CMS Pub 100-03 Chapter 1 Part 2 Section 100.1) when submitting for payment.

Key Coverage Criteria

Bariatric surgery for treatment of co-morbid conditions related to morbid obesity is payable when billed in accordance with CMS Pub 100-03 Medicare National Coverage Determinations Manual, Chapter 1 Part 2 Section 100.1.
Additional diagnoses listed in this local coverage article for Part A procedure codes and the article's listed CPT codes are covered for bariatric surgery to treat co-morbid conditions related to morbid obesity.
Controlled substance monitoring and drugs-of-abuse testing are covered when individually ordered by the treating clinician and meet the reasonable and necessary requirements specified in LCD L36393.
For covered laparoscopic restrictive procedures that require port replacement, bill CPT code 43771, 43772, or 43773.
Follow the LCD L33411 reasonable and necessary requirements for surgical management of morbid obesity when determining coverage.
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.

20 Active Policies

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J18-L36029, Urine Drug Testing

J18

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

A54923, Billing and Coding: Bariatric Surgery for Treatment of Co-Morbidities Conditions Related to Morbid Obesity

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A59416, Billing and Coding: Urine Drug Testing

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

NGS-J6-L39611, Urine Drug Testing

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L36393, Controlled Substance Monitoring and Drugs of Abuse Testing

FIRST_COAST-L33411, Surgical Management of Morbid Obesity

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

A57077, Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

A57145, Billing and Coding: Surgical Management of Morbid Obesity

NOVITAS-JH-L35006, Controlled Substance Monitoring and Drugs of Abuse Testing

NOVITAS-JH-L35003, Intraoperative Neurophysiological Testing

NOVITAS-JH-L34975, Neurophysiology Evoked Potentials (NEPs)

NOVITAS-JH-L35022, Bariatric Surgical Management of Morbid Obesity

NGS-JK-L39611, Urine Drug Testing

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

`M51.360`, Other intervertebral disc degeneration, lumbar region with discogenic back pain only

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M51.360, Other intervertebral disc degeneration, lumbar region with discogenic back pain only

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M51.360`, Other intervertebral disc degeneration, lumbar region with discogenic back pain only