Does S14.101A require prior authorization?

No, S14.101A does not require prior authorization (high confidence). Code is covered without prior authorization.

`S14.101A` — Unspecified injury at C1 level of cervical spinal cord, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.

Continuous intraoperative neurophysiologic monitoring provided one-on-one in the operating room (CPT 95940) is covered when it supports the covered indications in LCD L35003.
Report continuous intraoperative neurophysiologic monitoring in the operating room (95940) in addition to monitoring services provided from outside the operating room (G0453); coverage includes interpretation of baseline studies and removal of electrodes at the end of the procedure when supporting the LCD indications.
Reimbursement may be made for covered intraoperative monitoring when performed at POS 19, POS 21, POS 22, or POS 24.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
NC-stat® System (alone) is allowed when the beneficiary has a high pre-test probability or prior probability of Carpal Tunnel Syndrome, using CPT 95905.

A57597 — Billing and Coding: Somatosensory Testing

J05

L34594 — Nerve Conduction Studies and Electromyography

J05

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

L34624 — Somatosensory Testing

J05

L35098 — Nerve Conduction Studies and Electromyography

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