Does S34.109D require prior authorization?

No, S34.109D does not require prior authorization (high confidence). Covered without prior authorization.

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`S34.109D`, Unspecified injury to unspecified level of lumbar spinal cord, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high 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.

7 Active Policies

A57455, Billing and Coding: Urodynamics

NGS-J6-L33576, Urodynamics

FIRST_COAST-L33958, Somatosensory Testing

FIRST_COAST-L33941, Routine Foot Care

NGS-JK-L33576, Urodynamics

A57188, Billing and Coding: Routine Foot Care

A57540, Billing and Coding: Somatosensory Testing

`S34.109D`, Unspecified injury to unspecified level of lumbar spinal cord, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

S34.109D, Unspecified injury to unspecified level of lumbar spinal cord, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

`S34.109D`, Unspecified injury to unspecified level of lumbar spinal cord, subsequent encounter