Does S14.111D require prior authorization?

No, S14.111D does not require prior authorization (high confidence). Covered without prior authorization.

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`S14.111D`, Complete lesion at C1 level of cervical spinal cord, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

For CPT 97032, document the type of electrical stimulation (including 'manual'/'attended'), area(s) treated, and if used for muscle weakness provide objective strength ratings and functional deficits; if used for pain provide pain rating, pain location, and effect on function.
For HCPCS G0283, document the type of electrical stimulation (e.g., TENS, IFC), area(s) treated, and objective/subjective measures showing impact on pain intensity/location/functional impact and/or swelling.
For non-implantable pelvic floor stimulation, document cognitive intactness, patient motivation, and a failed documented trial of PME training (defined as no clinically significant improvement after 4 weeks of an ordered PME plan).

Key Coverage Criteria

Attended/manual electrical stimulation (CPT 97032) is covered when the qualified professional provides direct 1-on-1 patient contact to apply/manualy adjust stimulation (e.g., direct motor point stimulation, FES/NMES when combined with therapeutic exercise/neuromuscular reeducation/functional activities).
Non-implantable pelvic floor electrical stimulation delivered via vaginal or anal probes (reportable as CPT 97032) is covered for 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.
Unattended/supervised electrical stimulation provided as part of a therapy plan of care (HCPCS G0283) is covered for non-wound indications (e.g., TENS, IFC, cyclical muscle stimulation) when used to control pain and/or swelling and when objective/subjective improvement is documented.
Electromagnetic therapy (HCPCS G0329) is covered for chronic stage III and IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care.
Unattended electrical stimulation for wound management (HCPCS G0281) is covered for chronic stage III and IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that have not shown measurable healing after 30 days of conventional care.
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.

20 Active Policies

NGS-J6-L33576, Urodynamics

A57455, Billing and Coding: Urodynamics

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

FIRST_COAST-L33941, Routine Foot Care

A57123, Billing and Coding: Nerve Conduction Studies and Electromyography

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

NOVITAS-JH-L35081, Nerve Conduction Studies and Electromyography

NGS-JK-L33576, Urodynamics

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

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

NOVITAS-JL-L35081, Nerve Conduction Studies and Electromyography

A54095, Billing and Coding: Nerve Conduction Studies and Electromyography

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

A53065, Billing and Coding: Outpatient Physical Therapy

A56619, Billing and Coding: Nerve Conduction Studies and Electromyography

A57188, Billing and Coding: Routine Foot Care

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

A54969, Billing and Coding: Nerve Conduction Studies and Electromyography

`S14.111D`, Complete lesion at C1 level of cervical spinal cord, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

S14.111D, Complete lesion at C1 level of cervical spinal cord, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`S14.111D`, Complete lesion at C1 level of cervical spinal cord, subsequent encounter