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ICD-10-CM S15.199S, Other specified injury of unspecified vertebral artery, sequela | No Prior Auth

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`S15.199S`, Other specified injury of unspecified vertebral artery, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Maintain all documentation in the patient’s medical record; every page must be legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

The submitted CPT/HCPCS code must accurately describe the service performed.

Medical records must document clinical history, systems review, physical examination, and the evaluation findings that justify the medical necessity and skilled need for SLP services.

Evaluation and diagnostic services must include standardized test results (when used), interpretation, and a written report as well as treatment/re-evaluation plans per CMS Medicare Benefit Policy Manual Chapter 15.

Key Coverage Criteria

Speech-language pathology (SLP) services for treatment or evaluation of communication disorders when determined reasonable and necessary per LCD L35070.
Selection and prescription of speech-generating devices should be billed with CPT code 92607.
Adaptation and training for speech-generating devices should be billed with CPT code 92609.
Report group therapy with CPT code 92508 when patients are not receiving direct one-on-one contact and are supervised by the therapist.
Use the appropriate CPT evaluation code for re-evaluations in SLP because CPT does not define a distinct re-evaluation code.
SLP services are covered when necessary for diagnosis and treatment of speech, language, voice, fluency, articulation, and cognitive-communication impairments resulting in communication disabilities due to disease, injury, or loss of a body part.

3 Active Policies

NOVITAS-JH-L35070, Speech - Language Pathology (SLP) Services: Communication Disorders

JH

NOVITAS-JL-L35070, Speech - Language Pathology (SLP) Services: Communication Disorders

JL

A54111, Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders

JL

Related Codes

92508(3 policies)92521(3 policies)92522(3 policies)92523(3 policies)92524(3 policies)92597(3 policies)92607(3 policies)92507(3 policies)

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