Documentation requirements
Appropriate ICD-10-CM codes must be submitted with each claim. Claims submitted without such evidence will be denied as not medically necessary.
It is not enough to link the procedure code to a payable ICD-10-CM code. The diagnosis or clinical suspicion must be present for the procedure to be paid, and the patient's medical record must document that the coverage criteria in this policy have been met.
Covered services must meet general community standards of appropriate medical care. For example, extremely mild symptoms of very short duration may not justify procedures or testing, even though a listed ICD-10-CM symptom might superficially be met. Inclusion of certain "not otherwise specified" codes does not mean that any other associated disorder is covered.
Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim that lacks the necessary information to process that claim.
CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 3, §3.4.1.3 Diagnosis Code Requirements
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 92517 | HCPCS | Covered |
| 92518 | HCPCS | Covered |
| 92519 | HCPCS | Covered |
| 92537 | HCPCS | Covered |
| 92538 | HCPCS | Covered |
| 92540 | HCPCS | Covered |
| 92541 | HCPCS | Covered |
| 92542 | HCPCS | Covered |
| 92544 | HCPCS | Covered |
| 92545 | HCPCS | Covered |
| 92546 | HCPCS | Covered |
| 92547 | HCPCS | Covered |
| 92548 | HCPCS | Covered |
| 92549 | HCPCS | Covered |