M99.14 — Subluxation complex (vertebral) of sacral region
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- The patient's medical record must contain documentation that fully supports medical necessity for services included within the related LCD, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- Medical record documentation must be available to Medicare upon request.
- 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.
Key Coverage Criteria
- Minimally-invasive surgical fusion of the sacroiliac (SI) joint is covered when the patient's medical record documents medical necessity per the related Local Coverage Determination (LCD), including relevant history, physical exam, and diagnostic test results supporting the procedure.
- 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.
- 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).
- Lumbar MRI is covered when imaging information is necessary to determine need for surgery or other aggressive therapy (e.g., work-up for metastatic cancer or preoperative planning).
- Lumbar MRI is covered to evaluate suspected spinal cord compression, including diagnosis and localization of spinal cord compression.
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
L36406 — Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
J06
A57431 — Billing and Coding: Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
J06
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