Does S12.431B require prior authorization?

No, S12.431B does not require prior authorization (high confidence). Code is covered without prior authorization.

`S12.431B` — Unspecified traumatic nondisplaced spondylolisthesis of fifth cervical vertebra, initial encounter for open fracture

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All services ordered or rendered to Medicare beneficiaries must be signed; providers/suppliers must notify beneficiaries in writing prior to rendering the service if aware the test/item/procedure may not be covered.
A valid ICD-10-CM diagnosis code that best describes the patient's condition must be reported on the claim; claims without a valid ICD-10-CM code will be returned as incomplete under Section 1833(e).
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
The patient's medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.

Bone mass measurement tests are covered when ordered by the treating physician or a qualified non-physician practitioner authorized by state law.
An initial bone mass measurement is covered (Medicare reimbursement for an initial bone mass measurement may be allowed only once, regardless of sites studied).
A DXA confirmatory test may be performed and covered as a baseline for future monitoring (exception to the 'one type only' rule).
CPT code 77082 (vertebral fracture assessment) is covered when medically necessary, with symptoms documented and when results are anticipated to be used in patient management.
Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
Beneficiary is under the care of a physician.

L39788 — Cervical Fusion

J05

A59664 — Billing and Coding: Cervical Fusion

J05

A59632 — Billing and Coding: Cervical Fusion

J06

L39770 — Cervical Fusion

J06

A59674 — Billing and Coding: Cervical Fusion

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