Does M43.13 require prior authorization?

No, M43.13 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`M43.13` — Spondylolisthesis, cervicothoracic region

ICD-10-CM

Prior Authorization

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Documentation Required

Refer to LCD L34975 for the detailed reasonable and necessary clinical criteria and documentation required to support coverage of NEPs.
Use CPT codes 95925, 95926, 95927, 95928, 95929, 95938, and 95939 for Somatosensory Evoked Potentials/Responses (SEPs/SERs).
Use CPT codes 92651, 92652, and 92653 for Brainstem Auditory Evoked Potentials/Responses (BAEPs/BAERs).
Use CPT code 95930 for Visual Evoked Potentials/Responses (VEPs/VERs).

Key Coverage Criteria

Neurophysiology Evoked Potentials (NEPs) — including Somatosensory Evoked Potentials (SEPs), Brainstem Auditory Evoked Potentials (BAEPs/BAERs), and Visual Evoked Potentials (VEPs/VERs) — are covered when determined to be reasonable and necessary in accordance with LCD L34975.
Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.
EMG and/or nerve conduction studies are indicated for evaluation of suspected radiculopathy.
EMG and/or nerve conduction studies are indicated for evaluation of suspected mononeuropathy (single-nerve entrapment or injury).
EMG and/or nerve conduction studies are indicated for evaluation of suspected polyneuropathy or mononeuropathy multiplex.
EMG is indicated for evaluation of suspected myopathy.

20 Active Policies

L34594 — Nerve Conduction Studies and Electromyography

J05

L39788 — Cervical Fusion

J05

L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J05

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

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A clinical history from the referral source indicating the need for testing must be available in the medical record and retrievable for review.

If an E/M service is billed as separate and identifiable, medical record must document medical necessity and the E/M CPT code must be billed with modifier 25.

— Billing and Coding: Cervical Fusion

A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J05

L35098 — Nerve Conduction Studies and Electromyography

J06

A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography

J06

L39770 — Cervical Fusion

J06

A59632 — Billing and Coding: Cervical Fusion

J06

A58893 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J06

L39139 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J06

A59764 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J09

L39877 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J09

A59763 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J09

A59674 — Billing and Coding: Cervical Fusion

J09

L39799 — Cervical Fusion

J09

L35003 — Intraoperative Neurophysiological Testing

J12

A59766 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J12

A56773 — Billing and Coding: Neurophysiology Evoked Potentials (NEPs)

J12

M43.13 — Spondylolisthesis, cervicothoracic region