Does M75.100 require prior authorization?

No, M75.100 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

Backwork Sign up free

`M75.100`, Unspecified rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic

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 article provides billing and coding guidance and references LCD L39116; required documentation (e.g., medical records, prior authorization, specific forms) is not specified here and must be obtained from LCD L39116.
Billing, coding, and documentation requirements (e.g., required medical record elements, coding guidance, prior authorization if applicable) are specified in LCD L39139 and accompanying billing guidance; review LCD L39139 for the exact documentation required for claims.
This billing and coding article provides billing and coding guidance for Local Coverage Determination (LCD) L39575 regarding amniotic and placental-derived product injections/applications for musculoskeletal, non-wound indications.

Key Coverage Criteria

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).
No explicit covered indications are stated in this document. The text describes investigational/experimental uses of stem cell and cell-based therapies in multiple clinical scenarios, including:
Ischemic heart disease / acute myocardial infarction (AMI) — investigations of intracoronary or intramyocardial delivery of bone marrow mononuclear cells (BMCs/BM-MNC), mesenchymal stem cells (MSCs), cardiosphere-derived cells (CDCs), autologous skeletal myoblasts (ASM), and allogeneic MSCs.

11 Active Policies

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

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

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

AETNA-CPB-0697, Intraoperative Neurophysiological Monitoring

AETNA-CPB-0204, Manipulation Under General Anesthesia

A59374, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

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

AETNA-CPB-0207, Prolotherapy and Sclerotherapy

AETNA-CPB-0244, Skin and Soft Tissue Substitutes

AETNA-CPB-0599, Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell Transplantation

`M75.100`, Unspecified rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic

Prior Authorization

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

M75.100, Unspecified rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic

Prior Authorization

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

`M75.100`, Unspecified rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic