Does G54.2 require prior authorization?

No, G54.2 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G54.2` — Cervical root disorders, not elsewhere classified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation for CPT 97010, 97018, 97022, and 97026 must reflect medical necessity and be made available to the MAC upon request.
When billing a Z-code as the diagnosis, documentation must include the orthotic/prosthetic device name, date patient received the device, and date training/teaching began.
Documentation for CPT 97542 wheelchair propulsion training must relate the training to expected, attainable functional goals for the patient and/or caregiver.
Physical therapists must report patient contact time in 15-minute increments and bill using G0151 for physical therapy time reporting.

CPT 97110 may be billed when treating impairments of exercise tolerance due to cardiopulmonary impairments.
CPT 97542 (wheelchair management training) may be billed for wheelchair propulsion training when the training is tied to expected functional goals attainable by the patient or caregiver.
Home health physical therapy services are appropriate when based on impairments of body structure/function and demonstrable functional limitations consistent with the related LCD.
Nerve conduction studies (NCS) without needle electromyography (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the diagnosis codes G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53 is reported.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when diagnosis code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when diagnosis code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.

L34624 — Somatosensory Testing

J05

L34623 — Intraoperative Neurophysiological Testing

J05

L34594 — Nerve Conduction Studies and Electromyography

J05

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

A57597 — Billing and Coding: Somatosensory Testing

Ask Verity about documentation requirements, denial risks, or coverage in your state.