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ICD-10-CM S14.0XXA, Concussion and edema of cervical spinal cord, initial encounter | No Prior Auth

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`S14.0XXA`, Concussion and edema of cervical spinal cord, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Refer to LCD L34975 for the detailed reasonable and necessary clinical criteria and documentation required to support coverage of NEPs.
Use CPT codes 95925, 95926, 95927, 95928, 95929, 95938, and 95939 for Somatosensory Evoked Potentials/Responses (SEPs/SERs).
Use CPT codes 92651, 92652, and 92653 for Brainstem Auditory Evoked Potentials/Responses (BAEPs/BAERs).

Use CPT code 95930 for Visual Evoked Potentials/Responses (VEPs/VERs).

All documentation must be maintained in the patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.

The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

Key Coverage Criteria

Neurophysiology Evoked Potentials (NEPs) — including Somatosensory Evoked Potentials (SEPs), Brainstem Auditory Evoked Potentials (BAEPs/BAERs), and Visual Evoked Potentials (VEPs/VERs) — are covered when determined to be reasonable and necessary in accordance with LCD L34975.
Nerve conduction studies (NCS) without needle EMG (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following ICD-10-CM codes is reported: 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.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when ICD-10-CM code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when ICD-10-CM code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.

20 Active Policies

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L34056, Urodynamics

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

CGS-J18-L34056, Urodynamics

J18

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

J5

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

J5

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

J6

NGS-J6-L33576, Urodynamics

J6

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

J6

A57455, Billing and Coding: Urodynamics

J6

WPS-J8-L34594, Nerve Conduction Studies and Electromyography

J8

A57123, Billing and Coding: Nerve Conduction Studies and Electromyography

J9

FIRST_COAST-L33941, Routine Foot Care

J9

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

J9

NOVITAS-JH-L35081, Nerve Conduction Studies and Electromyography

JH

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

JH

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

JK

NGS-JK-L33576, Urodynamics

JK

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

JL

NOVITAS-JL-L35081, Nerve Conduction Studies and Electromyography

JL

Related Codes

G35.C1(20 policies)S14.111A(20 policies)G35.B1(20 policies)G35.B2(20 policies)G35.C2(20 policies)G35.A(20 policies)A52.15(20 policies)S14.112A(20 policies)

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