Does S32.039B require prior authorization?

No, S32.039B does not require prior authorization (high confidence). Covered without prior authorization.

`S32.039B`, Unspecified fracture of third lumbar vertebra, initial encounter for open fracture

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing and coding guidelines that complement Local Coverage Determination (LCD) L37848 for Lumbar Spinal Fusion; refer to LCD L37848 for clinical medical necessity criteria.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.

Continuous intraoperative neurophysiologic monitoring provided one-on-one in the operating room (CPT 95940) is covered when it supports the covered indications in LCD L35003.
Report continuous intraoperative neurophysiologic monitoring in the operating room (95940) in addition to monitoring services provided from outside the operating room (G0453); coverage includes interpretation of baseline studies and removal of electrodes at the end of the procedure when supporting the LCD indications.
Reimbursement may be made for covered intraoperative monitoring when performed at POS 19, POS 21, POS 22, or POS 24.
Neurophysiology Evoked Potentials (NEPs) — including Somatosensory Evoked Potentials (SEPs), Brainstem Auditory Evoked Potentials (BAEPs/BAERs), and Visual Evoked Potentials (VEPs/VERs) — are covered when determined to be reasonable and necessary in accordance with LCD L34975.
Cystometrogram (CPT 51725, 51726) is covered when performed to evaluate detrusor contractions, abnormalities of bladder compliance, measure post-void residual, determine bladder capacity, or detect detrusor sphincter dyssynergia (DSD).
Uroflowmetry (CPT 51736, 51741) is covered when used to measure urine flow rate to evaluate suspected reduced detrusor function (eg, neurologic lesion), obstructive causes (eg, BPH, cystocele), or increased flow suggesting stress urinary incontinence (SUI) or intrinsic sphincter dysfunction (ISD).

CGS-J15-L36460, Bone Mass Measurement

J15

CGS-J15-L34056, Urodynamics

J15

CGS-J18-L34056, Urodynamics

J18

CGS-J18-L36460, Bone Mass Measurement

J18

NOVITAS-JH-L35003, Intraoperative Neurophysiological Testing

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

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JL-L35003, Intraoperative Neurophysiological Testing

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

A56722, Billing and Coding: Intraoperative Neurophysiological Testing

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

NOVITAS-JL-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

A59040, Billing and Coding: Bone Mass Measurement

A56396, Billing and Coding: Lumbar Spinal Fusion

A56802, Billing and Coding: Urodynamics

A57132, Billing and Coding: Bone Mass Measurement