Does M99.10 require prior authorization?

No, M99.10 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`M99.10` — Subluxation complex (vertebral) of head region

ICD-10-CM

Prior Authorization

No Prior Auth Required

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

Documentation Required

Title XVIII of the Social Security Act, Section 1833(e) prohibits Medicare payment for any claim, which lacks the necessary information to process the claim.
Documentation must support that the scan is reasonable and necessary.
Accurate coding information must be provided with claims to differentiate CT and/or MRI scans from other radiology services and to make coverage determinations.
Sufficient documentation such as, history and physical notes, laboratory results, signs and symptoms of the disease to warrant the diagnostic test and to support the claim of reasonable and necessary must be included in the medical records.

Key Coverage Criteria

G71.21 | Nemaline myopathy
G83.0 | Diplegia of upper limbs
H44.19 | Other endophthalmitis
H44.532 | Leucocoria, left eye
H44.533 | Leucocoria, bilateral
H53.11 | Day blindness

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.

This information must be available to Medicare upon request.

Diagnoses used must be supported by appropriate documentation of medical necessity in the medical record.

A58412 — Billing and Coding: Chiropractic Services

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

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

J09

A58345 — Billing and Coding: Chiropractic Services

J12

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

A57215 — Billing and Coding: MRI and CT Scans of the Head and Neck

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

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

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

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

L35175 — MRI and CT Scans of the Head and Neck

L37373 — MRI and CT Scans of the Head and Neck

AETNA-CPB-0432 — Computerized Motion Diagnostic Imaging

A58865 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

M99.10 — Subluxation complex (vertebral) of head region