Does S34.125A require prior authorization?

No, S34.125A does not require prior authorization (high confidence). Covered without prior authorization.

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`S34.125A`, Incomplete lesion of L5 level of lumbar spinal cord, initial 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 patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s), the submitted CPT/HCPCS code must describe the service performed, and the record must clearly document medical necessity, the indication for ordering the test, and a clear diagnostic impression.

Key Coverage Criteria

Nerve conduction studies (NCS) without needle EMG (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following ICD-10-CM codes is reported: G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when ICD-10-CM code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when ICD-10-CM code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.
EMG and/or nerve conduction studies are indicated for evaluation of suspected radiculopathy.

20 Active Policies

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J15-L34056, Urodynamics

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

CGS-J18-L34056, Urodynamics

J18

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

WPS-J5-L34624, Somatosensory Testing

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57597, Billing and Coding: Somatosensory Testing

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L33576, Urodynamics

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A57455, Billing and Coding: Urodynamics

WPS-J8-L34594, Nerve Conduction Studies and Electromyography

WPS-J8-L34624, Somatosensory Testing

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

A57123, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L33941, Routine Foot Care

NOVITAS-JH-L35081, Nerve Conduction Studies and Electromyography

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

NOVITAS-JH-L35003, Intraoperative Neurophysiological Testing

`S34.125A`, Incomplete lesion of L5 level of lumbar spinal cord, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

S34.125A, Incomplete lesion of L5 level of lumbar spinal cord, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`S34.125A`, Incomplete lesion of L5 level of lumbar spinal cord, initial encounter