M48.30 — Traumatic spondylopathy, site unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Medical records must clearly document medical necessity for each test and include the reason for referral and a clear diagnostic impression.
- Data gathered during NCS should be available showing actual numeric results (latency, amplitude, etc.), preferably in tabular format.
- In cases of review, provide a hard copy of waveforms or a complete written report with interpretation upon request.
- Normal findings and abnormalities must document muscles tested, presence and type of spontaneous activity, characteristics of voluntary motor unit potentials, and interpretation.
Key Coverage Criteria
- NC-stat testing (CPT 95905) is allowed when the beneficiary has a high pre-test or prior probability of Carpal Tunnel Syndrome (CTS), limited to one service per arm.
- Use CPT 95870 for sampling muscles other than the paraspinals associated with the extremities that have been tested.
- Spinal cord stimulation (SCS) is covered for chronic pain when the clinical record documents the diagnosis and prior conservative therapies tried before the decision to use SCS.
- Temporary SCS trials (CPT 63650) are covered when performed in an office, ambulatory surgical center (ASC), outpatient hospital, or hospital with appropriate clinical documentation.
- One permanent SCS implant (CPT 63655) is covered per patient when performed in an ASC, outpatient hospital, or hospital and supported by medical necessity documentation.
- No specific clinical indications are provided in this billing and coding article; coverage criteria for amniotic and placental-derived product injections/applications for musculoskeletal non-wound indications are described in Local Coverage Determination L39116.
20 Active Policies
A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography
J06
L35098 — Nerve Conduction Studies and Electromyography
J06
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.