Does S44.91XA require prior authorization?

No, S44.91XA does not require prior authorization (high confidence). Covered without prior authorization.

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`S44.91XA`, Injury of unspecified nerve at shoulder and upper arm level, right arm, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

For CPT 97032, document the type of electrical stimulation (including 'manual'/'attended'), area(s) treated, and if used for muscle weakness provide objective strength ratings and functional deficits; if used for pain provide pain rating, pain location, and effect on function.
For HCPCS G0283, document the type of electrical stimulation (e.g., TENS, IFC), area(s) treated, and objective/subjective measures showing impact on pain intensity/location/functional impact and/or swelling.
For non-implantable pelvic floor stimulation, document cognitive intactness, patient motivation, and a failed documented trial of PME training (defined as no clinically significant improvement after 4 weeks of an ordered PME plan).

Key Coverage Criteria

Attended/manual electrical stimulation (CPT 97032) is covered when the qualified professional provides direct 1-on-1 patient contact to apply/manualy adjust stimulation (e.g., direct motor point stimulation, FES/NMES when combined with therapeutic exercise/neuromuscular reeducation/functional activities).
Non-implantable pelvic floor electrical stimulation delivered via vaginal or anal probes (reportable as CPT 97032) is covered for stress and/or urge urinary incontinence in cognitively intact, motivated patients who have failed a documented 4-week trial of pelvic muscle exercise (PME) training.
Unattended/supervised electrical stimulation provided as part of a therapy plan of care (HCPCS G0283) is covered for non-wound indications (e.g., TENS, IFC, cyclical muscle stimulation) when used to control pain and/or swelling and when objective/subjective improvement is documented.
Electromagnetic therapy (HCPCS G0329) is covered for chronic stage III and IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care.
Unattended electrical stimulation for wound management (HCPCS G0281) is covered for chronic stage III and IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that have not shown measurable healing after 30 days of conventional care.
Automated nerve conduction testing using the NC-stat (CPT 95905) is allowed only when there is a high pre-test or prior probability of carpal tunnel syndrome and the claim uses diagnosis code G56.01 or G56.02; allowed one service per arm.

20 Active Policies

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35906, Somatosensory Testing

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

A57597, Billing and Coding: Somatosensory Testing

WPS-J5-L34624, Somatosensory Testing

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

WPS-J8-L34624, Somatosensory Testing

NOVITAS-JH-L35003, Intraoperative Neurophysiological Testing

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

NOVITAS-JL-L35003, Intraoperative Neurophysiological Testing

A56722, Billing and Coding: Intraoperative Neurophysiological Testing

A56619, Billing and Coding: Nerve Conduction Studies and Electromyography

A53065, Billing and Coding: Outpatient Physical Therapy

A57041, Billing and Coding: Somatosensory Testing

A57307, Billing and Coding: Nerve Conduction Studies and Electromyography

`S44.91XA`, Injury of unspecified nerve at shoulder and upper arm level, right arm, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

S44.91XA, Injury of unspecified nerve at shoulder and upper arm level, right arm, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`S44.91XA`, Injury of unspecified nerve at shoulder and upper arm level, right arm, initial encounter