S44.91XA — Injury of unspecified nerve at shoulder and upper arm level, right arm, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- 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.
Key Coverage Criteria
- 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.
- 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.
- 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.
- Allow one NC‑stat® System service per arm (i.e., maximum one service billed with CPT 95905 per arm) for the indicated Carpal Tunnel Syndrome diagnosis.
20 Active Policies
A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography
J05
A57597 — Billing and Coding: Somatosensory Testing
J05
L34624 — Somatosensory Testing
J05
L34594 — Nerve Conduction Studies and Electromyography
J05
L35098 — Nerve Conduction Studies and Electromyography
Related Codes
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