Does M95.4 require prior authorization?

No, M95.4 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`M95.4` — Acquired deformity of chest and rib

ICD-10-CM

Prior Authorization

No Prior Auth Required

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

Documentation Required

Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include appropriate patient identification and dates of service.
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
If the provider performing the TEE is different from the ordering/referring physician, the performing provider must retain hard copy documentation of test results and interpretation and copies of the ordering/referring physician's order.

Key Coverage Criteria

Coverage of transesophageal echocardiogram (TEE) is determined by the reasonable and necessary clinical criteria in Local Coverage Determination L33756; refer to LCD L33756 for specific covered indications.
S22.21XS | Fracture of manubrium, sequela
S22.21XG | Fracture of manubrium, subsequent encounter for fracture with delayed healing
S22.21XK | Fracture of manubrium, subsequent encounter for fracture with nonunion
The results of the ECG must be relevant to the management of the patient.
When an ECG is performed on the same day as a cardiac stress test, but is not part of that stress test, it is separately payable. The ECG must add additional information to the stress test.

20 Active Policies

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

J05

A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

J05

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

Have a follow-up question?

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

The ordering/referring physician must state the reason for the TEE in the order; an order from the treating physician/nonphysician practitioner is required per 42 CFR 410.32(a).

Title XVIII of the Social Security Act, §1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

A57179 — Billing and Coding: Transesophageal Echocardiogram

J09

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

J09

L33756 — Transesophageal Echocardiogram

J09

L39877 — 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

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

J12

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

J12

L39575 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

L34315 — Electrocardiograms

L35163 — Plastic Surgery

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

L39118 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A59374 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A57327 — Billing and Coding: Electrocardiograms

A58867 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

AETNA-CPB-0452 — Noninvasive Positive Pressure Ventilation

M95.4 — Acquired deformity of chest and rib