Does S12.430A require prior authorization?

No, S12.430A does not require prior authorization (high confidence). Code is covered without prior authorization.

`S12.430A` — Unspecified traumatic displaced spondylolisthesis of fifth cervical vertebra, initial encounter for closed fracture

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
Report overnight oximetry using CPT code 94762 on claims.
A valid, written, physician-signed and dated plan of treatment must be established prior to provision of physical therapy and must outline type, amount, frequency, duration, functional diagnosis deficits, and anticipated short- and long-term goals.
Services must be ordered by a physician and the order must be documented in the medical record.

Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
Beneficiary is under the care of a physician.
Beneficiary is receiving services under a plan of care that is established and periodically reviewed by a physician.
Beneficiary needs skilled nursing care on an intermittent basis, or physical therapy, or speech-language pathology, or has a continued need for occupational therapy.
Physical therapy services ordered by a physician and provided by a qualified physical therapist or under the general supervision of a qualified physical therapist are covered when reasonable and necessary to treat illness/injury or to restore or maintain function.
Physical therapy services provided as a result of a valid written, physician-signed and dated plan of treatment established prior to provision that specifies type, amount, frequency, duration, functional diagnosis deficits, and short- and long-term goals are covered.

L34623 — Intraoperative Neurophysiological Testing

J05

A57604 — Billing and Coding: Intraoperative Neurophysiological Testing

J05

A59664 — Billing and Coding: Cervical Fusion

J05

L39788 — Cervical Fusion

J05

L39770 — Cervical Fusion

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