S33.100A — Subluxation of unspecified lumbar vertebra, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Key Coverage Criteria
- Manipulation under anesthesia of the spine is consideredmedically necessaryfor the treatment of vertebral fracture, complete dislocation of the spine, or acute traumatic incomplete dislocation (subluxation) of the spine.
2 Active Policies
ANTHEM-RAD.00034 — RAD.00034 Dynamic Spinal Visualization (Including Digital Motion X-ray and Cineradiography/Videofluoroscopy)
ANTHEM-CG-MED-65 — CG-MED-65 Manipulation Under Anesthesia
Related Codes
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