M46.50 — Other infective spondylopathies, site unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- The clinical record must document the elements leading to the diagnosis and the conservative therapies tried before electing SCS.
- Documentation must be available on request of patient selection criteria, radiologic imaging demonstrating proper lead placement, and medical necessity of trials, particularly for providers under post-payment review.
- Appropriate medical documentation to support a repeat trial must be submitted on appeal when extenuating circumstances led to trial failure.
- Providers must follow CCI edits for correct coding combinations prior to billing Medicare; specific applicable code combinations should be verified against the CCI.
Key Coverage Criteria
- Spinal cord stimulation (SCS) is covered for chronic pain when the clinical record documents the diagnosis and prior conservative therapies tried before the decision to use SCS.
- Temporary SCS trials (CPT 63650) are covered when performed in an office, ambulatory surgical center (ASC), outpatient hospital, or hospital with appropriate clinical documentation.
- One permanent SCS implant (CPT 63655) is covered per patient when performed in an ASC, outpatient hospital, or hospital and supported by medical necessity documentation.
- No specific clinical indications are provided in this billing and coding article; coverage criteria for amniotic and placental-derived product injections/applications for musculoskeletal non-wound indications are described in Local Coverage Determination L39116.
- 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.
- Coverage applies when the amniotic or placental-derived product injection/application meets the reasonable and necessary requirements of Local Coverage Determination L39877.
19 Active Policies
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
L39139 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J06
A58893 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J06
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