Does M80.8B9K require prior authorization?

No, M80.8B9K 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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`M80.8B9K`, Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with nonunion

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

For CPT 97032, document the type of electrical stimulation (including 'manual'/'attended'), area(s) treated, and if used for muscle weakness provide objective strength ratings and functional deficits; if used for pain provide pain rating, pain location, and effect on function.
For HCPCS G0283, document the type of electrical stimulation (e.g., TENS, IFC), area(s) treated, and objective/subjective measures showing impact on pain intensity/location/functional impact and/or swelling.
For non-implantable pelvic floor stimulation, document cognitive intactness, patient motivation, and a failed documented trial of PME training (defined as no clinically significant improvement after 4 weeks of an ordered PME plan).

Key Coverage Criteria

Attended/manual electrical stimulation (CPT 97032) is covered when the qualified professional provides direct 1-on-1 patient contact to apply/manualy adjust stimulation (e.g., direct motor point stimulation, FES/NMES when combined with therapeutic exercise/neuromuscular reeducation/functional activities).
Non-implantable pelvic floor electrical stimulation delivered via vaginal or anal probes (reportable as CPT 97032) is covered for stress and/or urge urinary incontinence in cognitively intact, motivated patients who have failed a documented 4-week trial of pelvic muscle exercise (PME) training.
Unattended/supervised electrical stimulation provided as part of a therapy plan of care (HCPCS G0283) is covered for non-wound indications (e.g., TENS, IFC, cyclical muscle stimulation) when used to control pain and/or swelling and when objective/subjective improvement is documented.
Electromagnetic therapy (HCPCS G0329) is covered for chronic stage III and IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care.
Unattended electrical stimulation for wound management (HCPCS G0281) is covered for chronic stage III and IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that have not shown measurable healing after 30 days of conventional care.
Intravenous bisphosphonate administration is covered for treatment of osteoporosis when medical record documents need for IV route, including description of treatment failure of oral or self‑administered osteoporosis drugs.

20 Active Policies

CGS-J15-L36460, Bone Mass Measurement

J15

CGS-J18-L36460, Bone Mass Measurement

J18

WPS-J5-L34648, Bisphosphonate Drug Therapy

WPS-J5-L34658, Vitamin D Assay Testing

A57484, Billing and Coding: Vitamin D Assay Testing

WPS-J5-L34623, Intraoperative Neurophysiological Testing

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

A57604, Billing and Coding: Intraoperative Neurophysiological Testing

A56907, Billing and Coding: Bisphosphonate Drug Therapy

WPS-J8-L34648, Bisphosphonate Drug Therapy

WPS-J8-L34658, Vitamin D Assay Testing

WPS-J8-L34623, Intraoperative Neurophysiological Testing

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

A57206, Billing and Coding: Lumbar MRI

A57311, Billing and Coding: Physical Therapy - Home Health

A57132, Billing and Coding: Bone Mass Measurement

A53065, Billing and Coding: Outpatient Physical Therapy

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

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

`M80.8B9K`, Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with nonunion

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M80.8B9K, Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with nonunion

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M80.8B9K`, Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with nonunion