Does M48.36 require prior authorization?

No, M48.36 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`M48.36` — Traumatic spondylopathy, lumbar region

ICD-10-CM

Prior Authorization

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Documentation Required

For wound-related modalities (G0281, G0329) document wound etiology and duration and prior treatments by physician, non-physician practitioner, nurse, and/or therapist (additional required wound documentation text truncated in source).
For 97032, document the type of electrical stimulation (specify 'manual' and 'attended'), area(s) treated, and when used for muscle weakness include objective strength ratings and functional deficits; when used for pain include pain rating, pain location, and effect of pain on function.
For non-implantable pelvic floor stimulation, document that the patient is cognitively intact and motivated, that a documented PME training trial was completed (4 weeks) with no clinically significant improvement, and that the nerve supply to the muscle is intact.

Key Coverage Criteria

CPT 97032 (attended/manual electrical stimulation) is covered when delivered with direct 1-on-1 contact by qualified personnel (examples: direct motor point stimulation; FES/NMES when performed with therapeutic exercise, neuromuscular reeducation, or functional activities).
CPT 97032 may be billed for the application, instruction, and adjustment of a TENS unit or other probe-based stimulation (including determining trigger points) when provided as an attended/manual modality.
Non-implantable pelvic floor electrical stimulation (97032 for probes; G0283 for electrode-based delivery) is covered for treatment of stress and/or urge urinary incontinence in cognitively intact, motivated patients who have failed a documented 4-week trial of pelvic muscle exercise (PME) training.
HCPCS G0283 (unattended/supervised electrical stimulation) is covered for non-wound-care indications as part of a therapy plan of care when delivered without constant direct contact after skilled application (examples: TENS, IFC, cyclical muscle stimulation).
HCPCS G0329 (electromagnetic therapy) is covered for chronic stage III/IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that show no measurable signs of healing after 30 days of conventional care as part of a therapy plan of care.
HCPCS G0281 (unattended electrical stimulation for wounds) is covered for chronic stage III/IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that are not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care.

20 Active Policies

L34594 — Nerve Conduction Studies and Electromyography

J05

A57478 — Billing and Coding: 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

L35486 — Pelvic Floor Dysfunction: Anorectal Manometry and EMG

J05

Have a follow-up question?

Ask Verity about documentation requirements, denial risks, or coverage in your state.

For G0283, document the type of electrical stimulation (e.g., TENS, IFC), area(s) treated, and objective/subjective measures of impact on pain intensity, pain location, function, and/or swelling.

Electrodes used with unattended electrical stimulation (G0283) are included in the practice expense and should not be billed separately to Medicare or the patient.

A legible medical record must document the condition, clinical findings, relevant prior treatment, and clearly justify the necessity and reasonableness of the lumbar MRI.

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

A57630 — Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

J05

L38213 — Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

J05

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

J06

L35098 — Nerve Conduction Studies and Electromyography

J06

A57668 — Billing and Coding: 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

L39877 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J09

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

J09

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

J09

L39879 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J12

A59766 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J12

A57307 — Billing and Coding: Nerve Conduction Studies and Electromyography

A57206 — Billing and Coding: Lumbar MRI

A53064 — Billing and Coding: Outpatient Occupational Therapy

M48.36 — Traumatic spondylopathy, lumbar region