Does M70.89 require prior authorization?

No, M70.89 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`M70.89` — Other soft tissue disorders related to use, overuse and pressure multiple sites

ICD-10-CM

Prior Authorization

No Prior Auth Required

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

Documentation Required

Billing, coding, and documentation requirements (e.g., required medical record elements, coding guidance, prior authorization if applicable) are specified in LCD L39139 and accompanying billing guidance; review LCD L39139 for the exact documentation required for claims.
This billing and coding article references Local Coverage Determination LCD L39624 for coverage and documentation requirements for amniotic and placental-derived product injections/applications for musculoskeletal (non-wound) indications; the LCD text was not provided so specific documentation requirements cannot be extracted.
All documentation must be maintained in the patient medical record, legible, include patient identification, dates of service, and the legible signature of the responsible physician or non‑physician practitioner.

Key Coverage Criteria

Coverage for amniotic and placental-derived product injections/applications for musculoskeletal, non-wound indications is determined by Local Coverage Determination L39139; consult LCD L39139 for specific clinical indications and thresholds.
Trigger point injections (TPIs) reported with CPT 20552 (1–2 muscles) or CPT 20553 (3+ muscles) are covered when determined medically reasonable and necessary per the applicable Local Coverage Determination (LCD).
Only services that meet the LCD reasonable and necessary requirements and frequency limitations are considered covered; billing of TPIs must follow CPT coding guidance in the AMA CPT manual.
Trigger point injections are covered only when they meet the reasonable and necessary requirements in the related LCD L37913.
Coverage applies when the amniotic or placental-derived product injection/application meets the reasonable and necessary requirements of Local Coverage Determination L39877.
Amniotic and placental-derived product injections/applications are covered only when they meet the reasonable and necessary clinical requirements specified in LCD L39879 (Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound).

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

A59553 — Billing and Coding: Trigger Point Injections

J05

L39713 — Trigger Point Injections

J05

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

The submitted medical record must support the selected ICD‑10‑CM code(s) and the CPT/HCPCS code reported must accurately describe the service performed.

Procedural report must document indications and medical necessity, muscles injected, specific locations of trigger points treated, name and units of injectant, amount of medication used, and pre‑ and immediate post‑procedure percent pain relief.

Patient record should include assessment by the performing provider related to the complaint, relevant history, results of pertinent tests/procedures, signed and dated office visit/operative report, and a post‑procedure plan supporting medical necessity.

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

L39662 — Trigger Point Injections (TPI)

J06

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

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

L34211 — Trigger Point Injections (TPI)

L34427 — Outpatient Occupational Therapy

L34428 — Outpatient Physical Therapy

L34560 — Home Health Occupational Therapy

L34564 — Home Health Physical Therapy

L39116 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

L39656 — Trigger Point Injections (TPI)

M70.89 — Other soft tissue disorders related to use, overuse and pressure multiple sites