C9361, Collagen matrix nerve wrap (neuromend collagen nerve wrap), per 0.5 centimeter
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- No specific documentation requirements, prior authorization criteria, or required clinical documentation are stated in this CPB. (Policy contains literature review, statements of experimental/investigational status, and lists of CPT/HCPCS/ICD-10 codes not covered, but does not specify required documentation fields.)
Key Coverage Criteria
- Prompt repair of acute phrenic nerve transection due to trauma or surgery. (Note in policy: "Phrenic nerve reconstruction for the treatment of diaphragmatic paralysis (Note: this does not apply to prompt repair of acute phrenic nerve transection due to trauma or surgery)")
- No other specific indications are affirmatively listed as covered in this CPB; multiple nerve grafting and nerve reconstruction interventions are described in the literature review but are explicitly identified in this policy as experimental and investigational (see Limitations).
1 Active Policy
AETNA-CPB-0416, Nerve Grafting and Reconstruction: Selected Indications
Related Codes
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