S13.160S — Subluxation of C5/C6 cervical vertebrae, sequela
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- Documentation must support that the scan is reasonable and necessary.
- Accurate coding information must be provided with claims to differentiate CT and/or MRI scans from other radiology services and to make coverage determinations.
- Sufficient documentation such as, history and physical notes, laboratory results, signs and symptoms of the disease to warrant the diagnostic test and to support the claim of reasonable and necessary must be included in the medical records.
Key Coverage Criteria
- G71.21 | Nemaline myopathy
- G83.0 | Diplegia of upper limbs
- H44.19 | Other endophthalmitis
- H44.532 | Leucocoria, left eye
- H44.533 | Leucocoria, bilateral
- H53.11 | Day blindness
20 Active Policies
L39788 — Cervical Fusion
J05
A59664 — Billing and Coding: Cervical Fusion
J05
L39770 — Cervical Fusion
J06
A59632 — Billing and Coding: Cervical Fusion
J06
L39799 — Cervical Fusion
J09
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