76496
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Document the clinical context and specific purpose for performing the test
- Document that the test is technically reliable, clinically valid, and clinically useful for the stated purpose
- Document how test results will be used to make a clinical management decision expected to improve net health outcome
- Evidence or documentation should report test accuracy, patient symptoms, and functional outcomes.
Key Coverage Criteria
- Use of dynamic spinal visualization technologies to evaluate spinal disorders, including neck and back pain
- Vertebral motion analysis (with controlled movement and computerized tracking) to assess vertebral motion related to suspected spinal pathology
- Dynamic spinal visualization (including digital motion X‑ray) for patients being evaluated for back or neck pain when standard flexion/extension radiographs are being considered.
- Assessment of radiographic spinal instability (rotation and translation) to aid diagnosis and selection of treatment such as physical therapy, decompression, or spinal fusion.
- Assessment of the efficacy of a prior spinal fusion using flexion/extension radiographs or dynamic visualization.
- Individuals with neck or back pain.
6 Active Policies
ANTHEM-RAD.00034 — RAD.00034 Dynamic Spinal Visualization (Including Digital Motion X-ray and Cineradiography/Videofluoroscopy)
BCBSIL-RAD601.046 — Dynamic Spinal Visualization and Vertebral Motion Analysis
BCBSMT-RAD601.046 — Dynamic Spinal Visualization and Vertebral Motion Analysis
BCBSNM-RAD601.046 — Dynamic Spinal Visualization and Vertebral Motion Analysis
BCBSOK-RAD601.046
Related Codes
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