M40.03 — Postural kyphosis, cervicothoracic region
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- The medical record must document medical necessity including relevant history, physical examination, and results of pertinent diagnostic tests or procedures.
- A hard copy computer-generated recording of the test results and the provider's interpretation must be included in the patient's record.
- The somatosensory evoked potential (SEP) report must specify which nerves were tested, latencies at various testing points, and an evaluation stating whether values are normal or abnormal.
- If the performing provider differs from the ordering/referring provider, the performing provider must retain copies of the test results, interpretation, and the ordering/referring provider's order for the studies.
Key Coverage Criteria
- Somatosensory testing is covered when medically reasonable and necessary and documented in the patient's medical record (relevant history, physical exam, and pertinent diagnostic test results).
- Testing and interpretation are covered when ordered and/or furnished by qualified personnel who have documented training and experience in evoked potentials and electrodiagnostics per CMS guidance (accredited residency/fellowship, national certification, or accredited post-graduate training/AMA-AOA Category 1 CME).
- The technical component may be furnished by a physical therapist with ABPTS certification without physician supervision, or by a certified technician under supervision consistent with the MPFSDB supervision level assigned to the CPT code (e.g., Level 21 for CPT 95925, 92526, 95927, 95938).
- Intraoperative neurophysiological testing is billable only when coverage criteria and medical necessity in related LCD L34623 are met.
- Coverage for amniotic and placental-derived product injections/applications for musculoskeletal, non-wound indications is determined by Local Coverage Determination L39139; consult LCD L39139 for specific clinical indications and thresholds.
- Cervical fusion and related cervical spine fusion procedures are the only procedures covered under this policy; other joint or non-cervical spinal procedures (e.g., facet, sacroiliitis, epidural) are not covered by this policy.
20 Active Policies
A57604 — Billing and Coding: Intraoperative Neurophysiological Testing
J05
A59664 — Billing and Coding: Cervical Fusion
J05
L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
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