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ICD-10-CM S33.100A, Subluxation of unspecified lumbar vertebra, initial encounter | No Prior Auth

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`S33.100A`, Subluxation of unspecified lumbar 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)

Key Coverage Criteria

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.

2 Active Policies

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

ANTHEM-CG-MED-65, Manipulation Under Anesthesia

Related Codes

(2 policies)

S23.100A(2 policies)

S12.691S(2 policies)

S13.100A(2 policies)

S22.000A(2 policies)

S22.089S(2 policies)

S12.000A(2 policies)

S23.171S(2 policies)

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