Does S44.11XA require prior authorization?

No, S44.11XA does not require prior authorization (high confidence). Code is covered without prior authorization.

`S44.11XA` — Injury of median nerve at upper arm level, right arm, 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, be legible, include appropriate patient identification (e.g., full name, dates of service), and be available to the contractor upon request.
The medical record must identify the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
When NCSs and NEMG are performed on the same day for the same patient they must be reported on the same claim.

Regional or local nerve blocks performed as part of an operative procedure (e.g., adjunct to or sole means of regional/local anesthesia for the procedure) are not affected by this non-coverage policy and may be billed as anesthesia for the operative procedure.
Nerve conduction studies (NCS) without needle electromyography (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the diagnosis codes G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53 is reported.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when diagnosis code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when diagnosis code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
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.

L34594 — Nerve Conduction Studies and Electromyography

J05

A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography

J05

A57597 — Billing and Coding: Somatosensory Testing

J05

L34624 — Somatosensory Testing

J05

L35098 — Nerve Conduction Studies and Electromyography

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