Does S24.4XXA require prior authorization?

No, S24.4XXA does not require prior authorization (high confidence). Covered without prior authorization.

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`S24.4XXA`, Injury of thoracic sympathetic nervous system, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The clinical history from the referral source must indicate the need for testing and the medical record must contain pertinent clinical information available for review upon request.
If an E/M service is separately billable, the medical record must document medical necessity for the separate E/M and the CPT must be billed with modifier 25.
When testing exceeds the reasonable maximum number of studies listed in the policy table, the physician must provide supplementary documentation justifying the additional testing.

When repetitive stimulation neuromuscular junction testing (CPT 95937) is performed, the physician's report must document characteristics of the test including the rate of repetition of stimulation and timing of post-exercise or high-frequency stimulus measurements.

Key Coverage Criteria

Nerve conduction studies (CPT 95907-95913) and/or needle electromyography (CPT 95860-95864, 95867-95872, 95885-95887) are covered when medically necessary to evaluate Carpal Tunnel Syndrome (unilateral).
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate Carpal Tunnel Syndrome (bilateral).
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate radiculopathy.
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate mononeuropathy.
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate polyneuropathy or mononeuropathy multiplex.
Needle EMG and nerve conduction studies are covered when medically necessary to evaluate myopathy.

16 Active Policies

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

WPS-J8-L34594, Nerve Conduction Studies and Electromyography

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

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

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

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

A56619, Billing and Coding: Nerve Conduction Studies and Electromyography

A54969, Billing and Coding: Nerve Conduction Studies and Electromyography

A57307, Billing and Coding: Nerve Conduction Studies and Electromyography

A56034, Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

A56607, Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)

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S24.4XXA, Injury of thoracic sympathetic nervous system, initial encounter