Does S24.109S require prior authorization?

No, S24.109S 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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`S24.109S`, Unspecified injury at unspecified level of thoracic 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 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.
Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
Somatosensory evoked potential (SEP) testing should be billed using CPT codes 95925, 95926, 95927, or 95938 when an SEP study (not QST) is performed.

9 Active Policies

NGS-J6-L33576, Urodynamics

A57455, Billing and Coding: Urodynamics

FIRST_COAST-L33941, Routine Foot Care

FIRST_COAST-L33958, Somatosensory Testing

NGS-JK-L33576, Urodynamics

A57540, Billing and Coding: Somatosensory Testing

AETNA-CPB-0229, Iontophoresis

A57188, Billing and Coding: Routine Foot Care

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

`S24.109S`, Unspecified injury at unspecified level of thoracic spinal cord, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

S24.109S, Unspecified injury at unspecified level of thoracic spinal cord, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

`S24.109S`, Unspecified injury at unspecified level of thoracic spinal cord, sequela