Does S23.100A require prior authorization?

No, S23.100A 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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`S23.100A`, Subluxation of unspecified thoracic vertebra, initial encounter

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.
Manipulation under anesthesia of the spine is consideredmedically necessaryfor the treatment of vertebral fracture, complete dislocation of the spine, or acute traumatic incomplete dislocation (subluxation) of the spine.

3 Active Policies

ANTHEM-RAD.00034, Dynamic Spinal Visualization (Including Digital Motion X-ray and Cineradiography/ Videofluoroscopy)

ANTHEM-CG-MED-65, Manipulation Under Anesthesia

A53058, Billing and Coding: Home Health Physical Therapy

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S23.100A, Subluxation of unspecified thoracic vertebra, initial encounter