Does S04.812A require prior authorization?

No, S04.812A does not require prior authorization (high confidence). Covered without prior authorization.

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`S04.812A`, Injury of olfactory [1st ] nerve, left side, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

When NCSs and NEMG are performed on the same day for the same patient they must be reported on the same claim.
When billing non-covered services/tests report unlisted neurological CPT 95999 and provide a description of the service/test in block 80 (Part A) or box 19 (Part B) or electronic equivalent; failure to include this information will result in Part A claims being returned and Part B claims rejected.
All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and include the legible signature of the responsible physician or non-physician practitioner.

Key Coverage Criteria

Nerve conduction studies (NCS) without needle electromyography (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the diagnosis codes G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53 is reported.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when diagnosis code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when diagnosis code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
Automated nerve conduction testing using the NC-stat (CPT 95905) is allowed only when there is a high pre-test or prior probability of carpal tunnel syndrome and the claim uses diagnosis code G56.01 or G56.02; allowed one service per arm.
If authorized by state law, physical therapists (PTs) are allowed to perform the technical and professional components of nerve conduction studies represented by CPT codes 95907-95913 consistent with a 7A supervision designation (effective 01/01/2013).
If authorized by state law, the technical component of neuromuscular junction testing CPT 95937 (TC) with supervision designation 7A is allowable for PTs consistent with the 7A description (effective 01/01/2013).

20 Active Policies

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

WPS-J8-L34594, Nerve Conduction Studies and Electromyography

A57123, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

NOVITAS-JH-L34975, Neurophysiology Evoked Potentials (NEPs)

NOVITAS-JH-L35081, Nerve Conduction Studies and Electromyography

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

NOVITAS-JL-L34975, Neurophysiology Evoked Potentials (NEPs)

A54095, Billing and Coding: Nerve Conduction Studies and Electromyography

A56773, Billing and Coding: Neurophysiology Evoked Potentials (NEPs)

NOVITAS-JL-L35081, Nerve Conduction Studies and Electromyography

A56612, Billing and Coding: CT of the Head

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

A57307, Billing and Coding: Nerve Conduction Studies and Electromyography

A56619, Billing and Coding: Nerve Conduction Studies and Electromyography

`S04.812A`, Injury of olfactory [1st ] nerve, left side, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

S04.812A, Injury of olfactory [1st ] nerve, left side, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`S04.812A`, Injury of olfactory [1st ] nerve, left side, initial encounter