Does S12.490D require prior authorization?

No, S12.490D does not require prior authorization (high confidence). Code is covered without prior authorization.

`S12.490D` — Other displaced fracture of fifth cervical vertebra, subsequent encounter for fracture with routine healing

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation for CPT 97010, 97018, 97022, and 97026 must reflect medical necessity and be made available to the MAC upon request.
When billing a Z-code as the diagnosis, documentation must include the orthotic/prosthetic device name, date patient received the device, and date training/teaching began.
Documentation for CPT 97542 wheelchair propulsion training must relate the training to expected, attainable functional goals for the patient and/or caregiver.
Physical therapists must report patient contact time in 15-minute increments and bill using G0151 for physical therapy time reporting.

CPT 97110 may be billed when treating impairments of exercise tolerance due to cardiopulmonary impairments.
CPT 97542 (wheelchair management training) may be billed for wheelchair propulsion training when the training is tied to expected functional goals attainable by the patient or caregiver.
Home health physical therapy services are appropriate when based on impairments of body structure/function and demonstrable functional limitations consistent with the related LCD.
G71.21 | Nemaline myopathy
G83.0 | Diplegia of upper limbs
H44.19 | Other endophthalmitis

A59664 — Billing and Coding: Cervical Fusion

J05

L39788 — Cervical Fusion

J05

A59632 — Billing and Coding: Cervical Fusion

J06

L39770 — Cervical Fusion

J06

L39799 — Cervical Fusion

J09

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