Does S12.691B require prior authorization?

No, S12.691B does not require prior authorization (high confidence). Code is covered without prior authorization.

`S12.691B` — Other nondisplaced fracture of seventh cervical vertebra, initial encounter for open fracture

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Billing and coding for immunizations must follow the coverage indications, limitations, and medical necessity criteria set forth in the associated Local Coverage Determination LCD L34596 (Immunizations).
Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
Report overnight oximetry using CPT code 94762 on claims.
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.

L34596 — Immunizations

J05

A59664 — Billing and Coding: Cervical Fusion

J05

A56900 — Billing and Coding: Immunizations

J05

L39788 — Cervical Fusion

J05

A59632 — Billing and Coding: Cervical Fusion

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