Does M47.12 require prior authorization?

No, M47.12 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`M47.12` — Other spondylosis with myelopathy, cervical region

ICD-10-CM

Prior Authorization

No Prior Auth Required

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

Documentation Required

All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
All documentation must be maintained in the patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.

Key Coverage Criteria

Continuous intraoperative neurophysiologic monitoring provided one-on-one in the operating room (CPT 95940) is covered when it supports the covered indications in LCD L35003.
Report continuous intraoperative neurophysiologic monitoring in the operating room (95940) in addition to monitoring services provided from outside the operating room (G0453); coverage includes interpretation of baseline studies and removal of electrodes at the end of the procedure when supporting the LCD indications.
Reimbursement may be made for covered intraoperative monitoring when performed at POS 19, POS 21, POS 22, or POS 24.
Nerve conduction studies (NCS) without needle EMG (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following ICD-10-CM codes is reported: 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.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when ICD-10-CM code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when ICD-10-CM code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.

20 Active Policies

L34623 — Intraoperative Neurophysiological Testing

J05

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

A57597 — Billing and Coding: Somatosensory Testing

J05

L34624 — Somatosensory Testing

J05

L39624

Have a follow-up question?

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

The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

The submitted medical record must support the selected ICD-10-CM code(s), the submitted CPT/HCPCS code must describe the service performed, and the record must clearly document medical necessity, the indication for ordering the test, and a clear diagnostic impression.

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

A57595 — Billing and Coding: Pelvic Floor Dysfunction: Anorectal Manometry and EMG

J05

L35486 — Pelvic Floor Dysfunction: Anorectal Manometry and EMG

J05

A57604 — Billing and Coding: Intraoperative Neurophysiological Testing

J05

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

J05

L34594 — Nerve Conduction Studies and Electromyography

J05

L35098 — Nerve Conduction Studies and Electromyography

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

A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography

J06

L34859 — Nerve Conduction Studies and Electromyography

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

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

J09

A57123 — Billing and Coding: Nerve Conduction Studies and Electromyography

J09

A56722 — Billing and Coding: Intraoperative Neurophysiological Testing

J12

M47.12 — Other spondylosis with myelopathy, cervical region