20938
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
2.94
Facility
$163.33
Non-Facility
$163.33
Documentation Required
- No specific documentation requirements (medical records, test results, or clinical notes) are stated in the provided text.
- No specific documentation requirements (medical records, test results, clinical notes) are stated in the provided text.
- No specific documentation requirements (medical records, test results, or clinical documentation) are specified in the provided text.
- No documentation requirements, required medical records, test results, or clinical documentation are specified in the provided text.
Key Coverage Criteria
- Spine Surgery — document titled 'Spine Surgery' (Humana Medicaid Medical Coverage Policy). (No specific covered diagnoses, procedures, or clinical scenarios are listed in the provided excerpt.)
- Artificial intervertebral disc replacement is an alternative to cervical and lumbar spinal fusion surgery for an individual suffering from pain due to degenerative disc disease (DDD).
- Trauma resulting in spinal nerve compression.
- Vertebral instability caused by infections or tumors.
- The artificial disc was designed to restore normal disc height, to preserve spinal flexibility and decrease degeneration of adjacent discs, which can occur as a result of DDD.
- Minimally invasive SIJ fusion may be performed with differently designed implants (eg, cylindrical threaded implants, hollow conical shaped barrel implants)
3 Active Policies
CARELON-spine-surgery-2024-01-01 — Spine Surgery
HUMANA-SPINE-SURGERY-VA-MEDICAID — Spine Surgery - MEDICAID - VIRGINIA
HUMANA-SPINE-SURGERY-SC-MEDICAID — Spine Surgery - MEDICAID - SOUTH CAROLINA
Related Codes
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