Does P11.5 require prior authorization?

No, P11.5 does not require prior authorization (high confidence). Code is covered without prior authorization.

`P11.5` — Birth injury to spine and spinal cord

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
The medical record 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.
The medical record must include the ordering provider’s assessment related to the patient’s complaint for that visit.

Continuous intraoperative neurophysiologic monitoring provided one-on-one in the operating room (CPT 95940) is covered when it supports the covered indications in LCD L35003.
Report continuous intraoperative neurophysiologic monitoring in the operating room (95940) in addition to monitoring services provided from outside the operating room (G0453); coverage includes interpretation of baseline studies and removal of electrodes at the end of the procedure when supporting the LCD indications.
Reimbursement may be made for covered intraoperative monitoring when performed at POS 19, POS 21, POS 22, or POS 24.
Somatosensory testing is covered when it is medically necessary, ordered by a referring/ordering physician, and the medical record documents relevant history, physical exam, and pertinent diagnostic tests supporting the need for the test.
Diagnostic somatosensory tests should be performed when test results are expected to influence or contribute to the patient’s course of treatment.
For diagnostic tests, report the test result if known; if result is not available, report the symptoms that prompted the test on the claim.

L34624 — Somatosensory Testing

J05

L34623 — Intraoperative Neurophysiological Testing

J05

A57597 — Billing and Coding: Somatosensory Testing

J05

A57604 — Billing and Coding: Intraoperative Neurophysiological Testing

J05

A56722 — Billing and Coding: Intraoperative Neurophysiological Testing

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