Does S12.101A require prior authorization?

No, S12.101A does not require prior authorization (high confidence). Code is covered without prior authorization.

`S12.101A` — Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When billing CPT 95905 for carpal tunnel, the diagnosis code must be G56.01 or G56.02.
Data gathered during NCS should be available to support the claim, although it is not necessary to include documentation with every claim submission.
Providers are expected to use CPT 95870 for sampling muscles other than paraspinals associated with tested extremities; CPT 95870 should not be billed for paraspinal sampling when extremity EMG codes 95860, 95861, 95863, or 95864 are also billed.
PTs performing the technical portion of needle EMG under the 6A designation must be ABPTS-certified as a qualified electrophysiologic clinical specialist and must be authorized by state law to perform the service.

Automated nerve conduction testing using the NC-stat (CPT 95905) is allowed only when there is a high pre-test or prior probability of carpal tunnel syndrome and the claim uses diagnosis code G56.01 or G56.02; allowed one service per arm.
If authorized by state law, physical therapists (PTs) are allowed to perform the technical and professional components of nerve conduction studies represented by CPT codes 95907-95913 consistent with a 7A supervision designation (effective 01/01/2013).
If authorized by state law, the technical component of neuromuscular junction testing CPT 95937 (TC) with supervision designation 7A is allowable for PTs consistent with the 7A description (effective 01/01/2013).
Needle electromyography CPT codes 95860-95872 and 95885-95887 have a 6A designation for the technical portion; PTs who are ABPTS-certified as qualified electrophysiologic clinical specialists and are authorized by state law may perform the technical and professional components according to the 6A description.
Electrodiagnostic nerve conduction studies and electromyography that provide real-time response parameters (amplitude, latency, configuration, conduction velocity) are acceptable for Medicare payment and should be used for provider interpretation.
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.

L34624 — Somatosensory Testing

J05

L34623 — Intraoperative Neurophysiological Testing

J05

A57597 — Billing and Coding: Somatosensory Testing

J05

A57604 — Billing and Coding: Intraoperative Neurophysiological Testing

J05

A59674 — Billing and Coding: Cervical Fusion

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