Does M62.5A2 require prior authorization?

No, M62.5A2 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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`M62.5A2`, Muscle wasting and atrophy, not elsewhere classified, back, lumbosacral

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 NCSs and NEMG are performed on the same day for the same patient they must be reported on the same claim.
When billing non-covered services/tests report unlisted neurological CPT 95999 and provide a description of the service/test in block 80 (Part A) or box 19 (Part B) or electronic equivalent; failure to include this information will result in Part A claims being returned and Part B claims rejected.
All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and include the legible signature of the responsible physician or non-physician practitioner.

Key Coverage Criteria

Nerve conduction studies (NCS) without needle electromyography (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the diagnosis codes G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53 is reported.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when diagnosis code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when diagnosis code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
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.

20 Active Policies

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

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

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

WPS-J8-L34594, Nerve Conduction Studies and Electromyography

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

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

A57123, Billing and Coding: Nerve Conduction Studies and Electromyography

NOVITAS-JH-L35081, Nerve Conduction Studies and Electromyography

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

NOVITAS-JL-L35081, Nerve Conduction Studies and Electromyography

A54095, Billing and Coding: Nerve Conduction Studies and Electromyography

A56679, Billing and Coding: Hospice The Adult Failure To Thrive Syndrome

A56619, Billing and Coding: Nerve Conduction Studies and Electromyography

A57206, Billing and Coding: Lumbar MRI

A57307, Billing and Coding: Nerve Conduction Studies and Electromyography

A54969, Billing and Coding: Nerve Conduction Studies and Electromyography

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

`M62.5A2`, Muscle wasting and atrophy, not elsewhere classified, back, lumbosacral

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M62.5A2, Muscle wasting and atrophy, not elsewhere classified, back, lumbosacral

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M62.5A2`, Muscle wasting and atrophy, not elsewhere classified, back, lumbosacral