Does M51.369 require prior authorization?

No, M51.369 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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`M51.369`, Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain

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

All documentation must be maintained in the patient medical record, be legible, include patient identification and the identity of the physician or non-physician practitioner responsible for care, and be available to the contractor upon request.
Medical record documentation maintained by the ordering/treating physician must indicate the medical necessity and clinical indication(s) that led to ordering the drug test and support the selected diagnosis and CPT/HCPCS code(s).
All tests must be ordered in writing by the treating provider and the order must specify all drugs/drug classes to be tested; the physician’s order must include the clinical indication/medical necessity.

Key Coverage Criteria

Urine, blood, or oral fluid specimens may be used for drug testing, with urine preferred for broad screening of common drugs.
Medicare Part B will pay for drug screening services when all coverage criteria, limitations, and medical necessity requirements of LCD DL34645 are met.
Claims for drug screening services are payable under Medicare Part B only in these places of service: office (11), urgent care (20), independent clinic (49), federally qualified health center — freestanding (50), rural health clinic — freestanding (72), and independent laboratory (81).
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.

20 Active Policies

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J18-L36029, Urine Drug Testing

J18

A56915, Billing and Coding: Urine Drug Testing

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

WPS-J5-L34645, Urine Drug Testing

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

NGS-J6-L39611, Urine Drug Testing

A59416, Billing and Coding: Urine Drug Testing

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

WPS-J8-L34645, Urine Drug Testing

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

FIRST_COAST-L33411, Surgical Management of Morbid Obesity

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

A57145, Billing and Coding: Surgical Management of Morbid Obesity

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

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

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

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

NOVITAS-JH-L35003, Intraoperative Neurophysiological Testing

`M51.369`, Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M51.369, Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M51.369`, Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain