Does M48.07 require prior authorization?

No, M48.07 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`M48.07` — Spinal stenosis, lumbosacral 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, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
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.
If documentation is requested, providers must submit a hard copy of waveforms and/or a complete written report with interpretation sufficient to support that the test was medically reasonable and necessary.

Key Coverage Criteria

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.
For covered laparoscopic restrictive procedures that require port replacement, bill CPT code 43771, 43772, or 43773.
Follow the LCD L33411 reasonable and necessary requirements for surgical management of morbid obesity when determining coverage.
Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.

20 Active Policies

A57597 — Billing and Coding: Somatosensory Testing

J05

A59553 — Billing and Coding: Trigger Point Injections

J05

L34624 — Somatosensory Testing

J05

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

A59434

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Reports must document normal findings and abnormalities with the nerves and muscles tested, presence and type of spontaneous activity, characteristics of voluntary unit potentials, interpretation, and the expected normal value range for the specific EDX device.

If analogous testing was previously performed, documentation must reference the date of prior testing, the results, and subsequent management based on those findings.

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

L39713 — Trigger Point Injections

J05

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

J05

L34594 — Nerve Conduction Studies and Electromyography

J05

A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography

J06

L39662 — Trigger Point Injections (TPI)

J06

A59487 — Billing and Coding: Trigger Point Injections (TPI)

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

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

J06

L34859 — Nerve Conduction Studies and Electromyography

J09

A59763 — 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

A57145 — Billing and Coding: Surgical Management of Morbid Obesity

J09

A57123 — Billing and Coding: Nerve Conduction Studies and Electromyography

J09

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

J09

M48.07 — Spinal stenosis, lumbosacral region