Does M75.00 require prior authorization?

No, M75.00 does not require prior authorization (low confidence). No active coverage policies found for this code.

`M75.00`, Adhesive capsulitis of unspecified shoulder

ICD-10-CM

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include patient identifiers (complete name, dates of service).
Medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Documentation should state whether the block was performed for diagnostic or therapeutic purposes.

Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
No specific clinical indications are provided in this billing and coding article; coverage criteria for amniotic and placental-derived product injections/applications for musculoskeletal non-wound indications are described in Local Coverage Determination L39116.
Coverage for amniotic and placental-derived product injections/applications for musculoskeletal, non-wound indications is determined by Local Coverage Determination L39139; consult LCD L39139 for specific clinical indications and thresholds.
Coverage applies when the amniotic or placental-derived product injection/application meets the reasonable and necessary requirements of Local Coverage Determination L39877.
Amniotic and placental-derived product injections/applications are covered only when they meet the reasonable and necessary clinical requirements specified in LCD L39879 (Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound).
Coverage requires manipulation under anesthesia for knee arthrofibrosis following TKA/knee surgery/fracture, or for shoulder adhesive capsulitis (frozen shoulder) when specified criteria are met (per InterQual CP: Procedures, Manipulation Under Anesthesia, Shoulder).

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

FIRST_COAST-L33933, Peripheral Nerve Blocks

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

Ask Backwork about documentation requirements, denial risks, or coverage in your state.