Does Q67.5 require prior authorization?

No, Q67.5 does not require prior authorization (high confidence). Covered without prior authorization.

`Q67.5`, Congenital deformity of spine

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.
Intraoperative EMG monitoring of the facial nerve during surgery for cholesteatoma, including mastoidotomy or mastoidectomy

AMBETTER-CP.MP.242, Pulmonary Function Testing

AETNA-CPB-0112, Surface Scanning and Macro Electromyography

AETNA-CPB-0582, Titanium Rib

AETNA-CPB-0697, Intraoperative Neurophysiological Monitoring

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

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