Does M96.820 require prior authorization?

No, M96.820 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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`M96.820`, Accidental puncture and laceration of a musculoskeletal structure during a musculoskeletal system procedure

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

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
The ordering/referring practitioner's assessment related to the patient's complaint and the specific reason for the test must be documented in the medical record.
The medical record must contain a referral/order on file for each non‑invasive vascular study performed.

Key Coverage Criteria

Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 50–79% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 80–99% if surgical correction has not been performed.
After carotid endarterectomy, repeat ipsilateral (unilateral) duplex examinations are allowable at approximately six weeks, six months, and one year post‑procedure during the first year.

16 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

A57594, Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

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

WPS-J5-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

A56758, Billing and Coding: Non-Invasive Vascular Studies

NGS-J6-L33627, Non-Invasive Vascular Studies

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

WPS-J8-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

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

NGS-JK-L33627, Non-Invasive Vascular Studies

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

A56697, Billing and Coding: Non-Invasive Vascular Studies

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

A56421, Billing and Coding: CT of the Abdomen and Pelvis

`M96.820`, Accidental puncture and laceration of a musculoskeletal structure during a musculoskeletal system procedure

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

M96.820, Accidental puncture and laceration of a musculoskeletal structure during a musculoskeletal system procedure

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

`M96.820`, Accidental puncture and laceration of a musculoskeletal structure during a musculoskeletal system procedure