Does S12.691S require prior authorization?

No, S12.691S does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

Backwork Sign up free

`S12.691S`, Other nondisplaced fracture of seventh cervical vertebra, sequela

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

Documentation for CPT 97010, 97018, 97022, and 97026 must reflect medical necessity and be made available to the MAC upon request.
When billing a Z-code as the diagnosis, documentation must include the orthotic/prosthetic device name, date patient received the device, and date training/teaching began.
Documentation for CPT 97542 wheelchair propulsion training must relate the training to expected, attainable functional goals for the patient and/or caregiver.

Key Coverage Criteria

CPT 97110 may be billed when treating impairments of exercise tolerance due to cardiopulmonary impairments.
CPT 97542 (wheelchair management training) may be billed for wheelchair propulsion training when the training is tied to expected functional goals attainable by the patient or caregiver.
Home health physical therapy services are appropriate when based on impairments of body structure/function and demonstrable functional limitations consistent with the related LCD.
CPT 97032 (attended/manual electrical stimulation) is covered when delivered with direct 1-on-1 contact by qualified personnel (examples: direct motor point stimulation; FES/NMES when performed with therapeutic exercise, neuromuscular reeducation, or functional activities).
CPT 97032 may be billed for the application, instruction, and adjustment of a TENS unit or other probe-based stimulation (including determining trigger points) when provided as an attended/manual modality.
Non-implantable pelvic floor electrical stimulation (97032 for probes; G0283 for electrode-based delivery) is covered for treatment of 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.

20 Active Policies

CGS-J15-L39741, Cervical Fusion

J15

CGS-J18-L39741, Cervical Fusion

J18

A59664, Billing and Coding: Cervical Fusion

WPS-J5-L39788, Cervical Fusion

A59632, Billing and Coding: Cervical Fusion

NGS-J6-L39770, Cervical Fusion

WPS-J8-L39788, Cervical Fusion

A59674, Billing and Coding: Cervical Fusion

FIRST_COAST-L39799, Cervical Fusion

NOVITAS-JH-L39793, Cervical Fusion

NGS-JK-L39770, Cervical Fusion

NOVITAS-JL-L39793, Cervical Fusion

A59668, Billing and Coding: Cervical Fusion

A53058, Billing and Coding: Home Health Physical Therapy

A53064, Billing and Coding: Outpatient Occupational Therapy

A53065, Billing and Coding: Outpatient Physical Therapy

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

A57311, Billing and Coding: Physical Therapy - Home Health

A59608, Billing and Coding: Cervical Fusion

A59624, Billing and Coding: Cervical Fusion

`S12.691S`, Other nondisplaced fracture of seventh cervical vertebra, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

S12.691S, Other nondisplaced fracture of seventh cervical vertebra, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`S12.691S`, Other nondisplaced fracture of seventh cervical vertebra, sequela