Does M47.25 require prior authorization?

No, M47.25 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`M47.25` — Other spondylosis with radiculopathy, thoracolumbar 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, be legible, include patient identifiers and dates of service, and be made available to the contractor upon request.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for the care and the submitted records must support the selected ICD-10-CM and CPT/HCPCS codes.
Procedural reports for SNRBs and TFESIs must document indications, medical necessity, and baseline pain score; SNRBs must also document percent pain relief achieved immediately after the injection.
Fluoroscopic/contrast films documenting final needle position and contrast flow (minimum two views) should be retained and made available upon request.

Key Coverage Criteria

Epidural steroid injections (ESIs) for pain management are covered when reasonable and necessary per Local Coverage Determination L33906.
Epidural injection CPT codes 62321, 62323, 64479, 64480, 64483 or 64484 used for postoperative acute post-thoracotomy pain (G89.12) or other acute postprocedural pain (G89.18) are exempt from the LCD diagnosis-code restrictions.
Epidural injection CPT 62323 used as part of an implantable infusion pump trial for severe spasticity is adjudicated under NCD 280.14 and is exempt from the diagnosis-code restrictions in this article.
Epidural injection CPT 62323 used for cerebrospinal fluid flow imaging (cisternography CPT 78630) is exempt from the diagnosis-code restrictions and should be billed on the same claim.
Diagnostic selective nerve root blocks (DSNRBs) are coded identically to epidural injections and when performed on a transforaminal level (TFESI CPT 64479, 64480, 64483, 64484) the -KX modifier must be appended to distinguish DSNRB from therapeutic epidural injection.
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.

20 Active Policies

L34624 — Somatosensory Testing

J05

L34594 — Nerve Conduction Studies and Electromyography

J05

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

L39054 — Epidural Steroid Injections for Pain Management

J05

A57597

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Patient medical record should include the performing provider's assessment related to the complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report to support medical necessity.

When performing a DSNRB, append the -KX modifier to the appropriate CPT line to distinguish the diagnostic procedure from a therapeutic epidural injection.

— Billing and Coding: Somatosensory Testing

A58777 — Billing and Coding: Epidural Steroid Injections for Pain Management

J05

L35486 — Pelvic Floor Dysfunction: Anorectal Manometry and EMG

J05

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

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

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

J06

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

A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography

J06

L39036 — Epidural Steroid Injections for Pain Management

J06

A58745 — Billing and Coding: Epidural Steroid Injections for Pain Management

J06

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

J09

A56651 — Billing and Coding: Epidural Steroid Injections for Pain Management

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

M47.25 — Other spondylosis with radiculopathy, thoracolumbar region