Does M53.83 require prior authorization?

No, M53.83 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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`M53.83`, Other specified dorsopathies, cervicothoracic 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

When billing J7999-KD, enter the name and total dose (mg or mcg) of each drug in Box 19 of the CMS-1500 or the appropriate electronic comment loop; if Box 19 cannot accommodate all information, attach the details to the paper claim.
If a portion of a single-dose vial is not used, submit the HCPCS code for the drug on a separate claim line and append modifier JW to indicate discarded/unused portion.
Separate payment may be made for pump refilling and/or adjustments; submit these services using the appropriate drug refill or maintenance CPT/HCPCS code that accurately describes the service rendered.

Key Coverage Criteria

Compounded medications for use in implantable infusion pumps may be covered by Medicare when their use meets all other criteria for services provided incident to a physician's service.
True off-the-shelf (non‑compounded) drugs used without compounding and administered via DME may be billed using the drug-specific HCPCS code and are reimbursed under CMS ASP methodology.
If Prialt® is implanted as a single agent in the pump, bill using HCPCS code J2278-KD.
Compounded single-agent or combination drug formulations used in implanted infusion pumps must be billed using HCPCS code J7999-KD for reimbursement.
Reconstructive plastic surgery is covered when performed for therapeutic purposes such as treatment of severe burns, facial repair following auto trauma, or similar reconstructive/therapeutic surgery.
Reduction mammoplasty is covered when the beneficiary has symptomatic breast hypertrophy (macromastia) with documented severe symptoms and demonstrable adverse impact on health-related quality of life as measured by an accepted breast-specific questionnaire, AND persistent signs/symptoms despite a reasonable trial of conservative therapy.

20 Active Policies

CGS-J15-L38773, Facet Joint Interventions for Pain Management

J15

CGS-J18-L38773, Facet Joint Interventions for Pain Management

J18

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

WPS-J5-L38841, Facet Joint Interventions for Pain Management

A58477, Billing and Coding: Facet Joint Interventions for Pain Management

A57452, Billing and Coding: Peripheral Nerve Blocks

NGS-J6-L35936, Facet Joint Interventions for Pain Management

NGS-J6-L36850, Peripheral Nerve Blocks

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

A57826, Billing and Coding: Facet Joint Interventions for Pain Management

WPS-J8-L38841, Facet Joint Interventions for Pain Management

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

FIRST_COAST-L33933, Peripheral Nerve Blocks

NGS-JK-L36850, Peripheral Nerve Blocks

NGS-JK-L35936, Facet Joint Interventions for Pain Management

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

A57221, Billing and Coding: Plastic Surgery

A56695, Billing and Coding: Implantable Infusion Pump

A57788, Billing and Coding: Peripheral Nerve Blocks

A57791, Billing and Coding: Spinal Cord Stimulators for Chronic Pain

`M53.83`, Other specified dorsopathies, cervicothoracic region

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M53.83, Other specified dorsopathies, cervicothoracic region

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M53.83`, Other specified dorsopathies, cervicothoracic region