Does M48.13 require prior authorization?

No, M48.13 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`M48.13` — Ankylosing hyperostosis [Forestier], cervicothoracic 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

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

J05

A58477 — Billing and Coding: Facet Joint Interventions for Pain Management

J05

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

J05

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

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Neuromuscular junction studies (CPT 95937) reports must document stimulation rate and any significant incremental or decremental responses and may be reported separately from motor/sensory NCS of the same nerves.

When testing exceeds the reasonable maximum numbers listed in the guidance table, the provider must supply supplementary documentation justifying the additional tests; documentation must also justify testing an asymptomatic contralateral limb for normative values.

L38841 — Facet Joint Interventions for Pain Management

J05

L35486 — Pelvic Floor Dysfunction: Anorectal Manometry and EMG

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

L35098 — Nerve Conduction Studies and Electromyography

J06

L35936 — Facet Joint Interventions for Pain Management

J06

A57826 — Billing and Coding: Facet Joint Interventions for Pain Management

J06

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

A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography

J06

L33930 — Facet Joint Interventions for Pain Management

J09

A59764 — 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

A57787 — Billing and Coding: Facet Joint Interventions for Pain Management

J09

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

J09

L34892 — Facet Joint Interventions for Pain Management

J12

M48.13 — Ankylosing hyperostosis [Forestier], cervicothoracic region