M48.01 — Spinal stenosis, occipito-atlanto-axial region
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- 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.
- Nerve conduction study reports must include numerical data (amplitude, latency, velocity) and F-wave descriptions must reference corresponding motor conduction data.
- Blink reflex (CPT 95933) reports should include bilateral recordings with ipsilateral and contralateral stimulation and note presence or absence of R1 and R2 components.
Key Coverage Criteria
- 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.
- EMG and nerve conduction studies are indicated for evaluation of suspected motor neuropathies (e.g., amyotrophic lateral sclerosis).
20 Active Policies
L39788 — Cervical Fusion
J05
L34594 — Nerve Conduction Studies and Electromyography
J05
A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
A57597 — Billing and Coding: Somatosensory Testing
J05
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