Does S12.040S require prior authorization?

No, S12.040S does not require prior authorization (high confidence). Code is covered without prior authorization.

`S12.040S` — Displaced lateral mass fracture of first cervical vertebra, sequela

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.

L39788 — Cervical Fusion

J05

A59664 — Billing and Coding: Cervical Fusion

J05

L39770 — Cervical Fusion

J06

A59632 — Billing and Coding: Cervical Fusion

J06

L39799 — Cervical Fusion

J09

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