Does S14.129S require prior authorization?

No, S14.129S does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`S14.129S`, Central cord syndrome at unspecified level of cervical spinal cord, 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

All documentation must be maintained in the medical record, be legible, include patient identification (e.g., full name, dates of service), and include the legible signature of the treating physician or non-physician practitioner.
The submitted medical record must support the selected ICD-10-CM code(s) and the CPT/HCPCS code must accurately describe the service performed.
When Q7, Q8, or Q9 is used, the medical record must document the specific Class A, B, and/or C findings and the complicating condition(s) that justify the modifier.

For podiatrist-submitted claims with ICD-10 codes marked with an asterisk, the claim must include the name of the M.D., D.O., or non-physician practitioner who diagnosed the complicating condition and the approximate date the beneficiary was last seen by that provider.

For podiatrist claims with non-asterisked ICD-10 codes, the claim must include the name of the M.D., D.O., non-physician practitioner, or the podiatrist who diagnosed the complicating condition.

For peripheral neuropathy diagnoses relying on loss of protective sensation, the record must document absence of sensation at two or more sites out of five tested on either foot using the 5.07 Semmes-Weinstein monofilament test.

Key Coverage Criteria

Routine foot care is covered only when the patient has one or more diagnoses listed in the LCD L33941 “ICD-10 Codes that Support Medical Necessity.”
Patients with peripheral neuropathy involving the feet (without vascular impairment) are covered when billed with the Group 3 ICD-10 codes appropriate for peripheral neuropathy.
Patients requiring anticoagulation therapy are covered when billed with the Group 4 ICD-10 codes documenting anticoagulation-related risk.
Patients with Group 2 (complicating) diagnoses may be covered when the claim includes the appropriate Q modifier (Q7, Q8, or Q9) and the medical record documents the required Class A, B, and/or C findings per the definitions.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.

10 Active Policies

A57455, Billing and Coding: Urodynamics

NGS-J6-L33576, Urodynamics

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L33941, Routine Foot Care

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

NGS-JK-L33576, Urodynamics

ANTHEM-DME.00022, Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES)

A57188, Billing and Coding: Routine Foot Care

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

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S14.129S, Central cord syndrome at unspecified level of cervical spinal cord, sequela