Does M62.261 require prior authorization?

No, M62.261 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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`M62.261`, Nontraumatic ischemic infarction of muscle, right lower leg

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

The clinical history from the referral source must indicate the need for testing and the medical record must contain pertinent clinical information available for review upon request.
If an E/M service is separately billable, the medical record must document medical necessity for the separate E/M and the CPT must be billed with modifier 25.
When testing exceeds the reasonable maximum number of studies listed in the policy table, the physician must provide supplementary documentation justifying the additional testing.

Key Coverage Criteria

Nerve conduction studies (CPT 95907-95913) and/or needle electromyography (CPT 95860-95864, 95867-95872, 95885-95887) are covered when medically necessary to evaluate Carpal Tunnel Syndrome (unilateral).
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate Carpal Tunnel Syndrome (bilateral).
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate radiculopathy.
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate mononeuropathy.
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate polyneuropathy or mononeuropathy multiplex.
Needle EMG and nerve conduction studies are covered when medically necessary to evaluate myopathy.

20 Active Policies

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

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

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

A56787, Billing and Coding: Nonvascular Extremity Ultrasound

NGS-J6-L33619, Nonvascular Extremity Ultrasound

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

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

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

WPS-J8-L34594, Nerve Conduction Studies and Electromyography

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-L33619, Nonvascular Extremity Ultrasound

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

A57114, Billing and Coding: Injection of Trigger Points

A57307, Billing and Coding: Nerve Conduction Studies and Electromyography

A57311, Billing and Coding: Physical Therapy - Home Health

A56619, Billing and Coding: Nerve Conduction Studies and Electromyography

A54969, Billing and Coding: Nerve Conduction Studies and Electromyography

`M62.261`, Nontraumatic ischemic infarction of muscle, right lower leg

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M62.261, Nontraumatic ischemic infarction of muscle, right lower leg

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M62.261`, Nontraumatic ischemic infarction of muscle, right lower leg