Does Q76.425 require prior authorization?

No, Q76.425 does not require prior authorization (high confidence). Covered without prior authorization.

`Q76.425`, Congenital lordosis, thoracolumbar region

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.
A legible medical record must document the condition, clinical findings, relevant prior treatment, and clearly justify the necessity and reasonableness of the lumbar MRI.
The documentation must clearly support the ICD-10-CM code(s) reported on the claim.
An attending or treating physician's order, properly signed and dated, is required for each lumbar MRI 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
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "H93.3x1 - H93.3x9" Disorders of acoustic nerve [compression].
ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "I06.0 - I06.9" Diseases of aortic valve.

AMBETTER-CP.MP.242, Pulmonary Function Testing

AETNA-CPB-0112, Surface Scanning and Macro Electromyography

AETNA-CPB-0697, Intraoperative Neurophysiological Monitoring

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

A57206, Billing and Coding: Lumbar MRI

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