M60.811 — Other myositis, right shoulder
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 medical record and made available to the contractor upon request, with every page legible and including patient identification (complete name, dates of service).
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
- The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- Results of the vitamin D testing and the resulting treatment regimen must be documented in the patient's medical record, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures (e.g., progress notes and written laboratory reports).
Key Coverage Criteria
- 25-hydroxy vitamin D testing (including fractions, if performed) is covered when deemed reasonable and necessary per Local Coverage Determination L33771.
- Urine, blood, or oral fluid specimens may be used for drug testing, with urine preferred for broad screening of common drugs.
- Medicare Part B will pay for drug screening services when all coverage criteria, limitations, and medical necessity requirements of LCD DL34645 are met.
- Claims for drug screening services are payable under Medicare Part B only in these places of service: office (11), urgent care (20), independent clinic (49), federally qualified health center — freestanding (50), rural health clinic — freestanding (72), and independent laboratory (81).
- Controlled substance monitoring and drugs-of-abuse testing are covered when individually ordered by the treating clinician and meet the reasonable and necessary requirements specified in LCD L36393.
- 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.
20 Active Policies
L34594 — Nerve Conduction Studies and Electromyography
J05
L34645 — Urine Drug Testing
J05
A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
A56915 — Billing and Coding: Urine Drug Testing
J05
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