LCD Reference Article Billing and Coding Article

Billing and Coding: Intraoperative Neurophysiological Testing

A57604

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Source Article ID
N/A
Article ID
A57604
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Intraoperative Neurophysiological Testing
Article Type
Billing and Coding
Original Effective Date
11/01/2019
Revision Effective Date
02/01/2024
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.

Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.

Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.

Article Guidance

Article Text

The billing and coding information in this article is dependent on the coverage indications, limitations, and/or medical necessity described in the related LCD L34623 Intraoperative Neurophysiological Testing.

Documentation Requirements
All documentation must be maintained in the patient’s medical record and available to the contractor upon request.

Every page of the medical record must be legible and include appropriate patient identification information (e.g. complete name, dates of service). The record must include the physician or non-physician practitioner responsible for providing the care of the patient.

The patient’s medical record should document the time spent in monitoring in correlation to the surgery performed.

The submitted medical record should support the use of the selected diagnosis code(s).
The submitted CPT/HCPCS code should describe the service performed.

Utilization Guidelines

Intraoperative neurophysiology monitoring should not be reported by the physician performing the operative procedure since it is included in the global package for the surgery.

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(400 Codes)
Group 1 Paragraph

Note: All ICD-10 codes listed below may be viewed as medically necessary. All ICD-10 codes must be coded to the highest level of specificity.

Group 1 Codes
Code Description
A18.01 Tuberculosis of spine
C41.2 Malignant neoplasm of vertebral column
C70.0 Malignant neoplasm of cerebral meninges
C70.1 Malignant neoplasm of spinal meninges
C72.0 Malignant neoplasm of spinal cord
C72.1 Malignant neoplasm of cauda equina
C72.21 Malignant neoplasm of right olfactory nerve
C72.22 Malignant neoplasm of left olfactory nerve
C72.31 Malignant neoplasm of right optic nerve
C72.32 Malignant neoplasm of left optic nerve
C72.41 Malignant neoplasm of right acoustic nerve
C72.42 Malignant neoplasm of left acoustic nerve
C72.50 Malignant neoplasm of unspecified cranial nerve
C72.59 Malignant neoplasm of other cranial nerves
C72.9 Malignant neoplasm of central nervous system, unspecified
C73 Malignant neoplasm of thyroid gland
C79.31 Secondary malignant neoplasm of brain
C79.32 Secondary malignant neoplasm of cerebral meninges
C79.49 Secondary malignant neoplasm of other parts of nervous system
D21.0 Benign neoplasm of connective and other soft tissue of head, face and neck
D32.0 Benign neoplasm of cerebral meninges
D32.1 Benign neoplasm of spinal meninges
D33.0 Benign neoplasm of brain, supratentorial
D33.1 Benign neoplasm of brain, infratentorial
D33.2 Benign neoplasm of brain, unspecified
D33.3 Benign neoplasm of cranial nerves
D33.4 Benign neoplasm of spinal cord
D33.7 Benign neoplasm of other specified parts of central nervous system
D33.9 Benign neoplasm of central nervous system, unspecified
D42.0 Neoplasm of uncertain behavior of cerebral meninges
D42.1 Neoplasm of uncertain behavior of spinal meninges
D42.9 Neoplasm of uncertain behavior of meninges, unspecified
D43.0 Neoplasm of uncertain behavior of brain, supratentorial
D43.1 Neoplasm of uncertain behavior of brain, infratentorial
D43.2 Neoplasm of uncertain behavior of brain, unspecified
D43.3 Neoplasm of uncertain behavior of cranial nerves
D43.4 Neoplasm of uncertain behavior of spinal cord
D43.8 Neoplasm of uncertain behavior of other specified parts of central nervous system
D44.3 Neoplasm of uncertain behavior of pituitary gland
D44.4 Neoplasm of uncertain behavior of craniopharyngeal duct
D44.5 Neoplasm of uncertain behavior of pineal gland
D44.6 Neoplasm of uncertain behavior of carotid body
D44.7 Neoplasm of uncertain behavior of aortic body and other paraganglia
D49.6 Neoplasm of unspecified behavior of brain
G06.1 Intraspinal abscess and granuloma
G40.011 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus
G40.019 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus
G40.111 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus
G40.119 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus
G40.211 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus
G40.219 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus
G45.0 Vertebro-basilar artery syndrome
G45.1 Carotid artery syndrome (hemispheric)
G45.2 Multiple and bilateral precerebral artery syndromes
G45.8 Other transient cerebral ischemic attacks and related syndromes
G45.9 Transient cerebral ischemic attack, unspecified
G46.0 Middle cerebral artery syndrome
G46.1 Anterior cerebral artery syndrome
G46.2 Posterior cerebral artery syndrome
G50.0 Trigeminal neuralgia
G50.1 Atypical facial pain
G52.9 Cranial nerve disorder, unspecified
G53 Cranial nerve disorders in diseases classified elsewhere
G54.0 Brachial plexus disorders
G54.1 Lumbosacral plexus disorders
G54.2 Cervical root disorders, not elsewhere classified
G54.3 Thoracic root disorders, not elsewhere classified
G54.4 Lumbosacral root disorders, not elsewhere classified
G56.11 Other lesions of median nerve, right upper limb
G56.12 Other lesions of median nerve, left upper limb
G56.13 Other lesions of median nerve, bilateral upper limbs
G56.21 Lesion of ulnar nerve, right upper limb
G56.22 Lesion of ulnar nerve, left upper limb
G56.23 Lesion of ulnar nerve, bilateral upper limbs
G56.31 Lesion of radial nerve, right upper limb
G56.32 Lesion of radial nerve, left upper limb
G56.33 Lesion of radial nerve, bilateral upper limbs
G57.01 Lesion of sciatic nerve, right lower limb
G57.02 Lesion of sciatic nerve, left lower limb
G57.03 Lesion of sciatic nerve, bilateral lower limbs
G80.4 Ataxic cerebral palsy
G80.8 Other cerebral palsy
G80.9 Cerebral palsy, unspecified
G93.5 Compression of brain
G95.0 Syringomyelia and syringobulbia
H71.01 Cholesteatoma of attic, right ear
H71.02 Cholesteatoma of attic, left ear
H71.03 Cholesteatoma of attic, bilateral
H71.11 Cholesteatoma of tympanum, right ear
H71.12 Cholesteatoma of tympanum, left ear
H71.13 Cholesteatoma of tympanum, bilateral
H71.21 Cholesteatoma of mastoid, right ear
H71.22 Cholesteatoma of mastoid, left ear
H71.23 Cholesteatoma of mastoid, bilateral
H71.31 Diffuse cholesteatosis, right ear
H71.32 Diffuse cholesteatosis, left ear
H71.33 Diffuse cholesteatosis, bilateral
H71.91 Unspecified cholesteatoma, right ear
H71.92 Unspecified cholesteatoma, left ear
H71.93 Unspecified cholesteatoma, bilateral
H74.41 Polyp of right middle ear
H74.42 Polyp of left middle ear
H74.43 Polyp of middle ear, bilateral
H83.11 Labyrinthine fistula, right ear
H83.12 Labyrinthine fistula, left ear
H83.13 Labyrinthine fistula, bilateral
I60.00 Nontraumatic subarachnoid hemorrhage from unspecified carotid siphon and bifurcation
I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation
I60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation
I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery
I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery
I60.2 Nontraumatic subarachnoid hemorrhage from anterior communicating artery
I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery
I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery
I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery
I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery
I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery
I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries
I60.8 Other nontraumatic subarachnoid hemorrhage
I60.9 Nontraumatic subarachnoid hemorrhage, unspecified
I61.0 Nontraumatic intracerebral hemorrhage in hemisphere, subcortical
I61.1 Nontraumatic intracerebral hemorrhage in hemisphere, cortical
I61.2 Nontraumatic intracerebral hemorrhage in hemisphere, unspecified
I61.3 Nontraumatic intracerebral hemorrhage in brain stem
I61.4 Nontraumatic intracerebral hemorrhage in cerebellum
I61.5 Nontraumatic intracerebral hemorrhage, intraventricular
I61.6 Nontraumatic intracerebral hemorrhage, multiple localized
I61.8 Other nontraumatic intracerebral hemorrhage
I61.9 Nontraumatic intracerebral hemorrhage, unspecified
I62.00 Nontraumatic subdural hemorrhage, unspecified
I62.01 Nontraumatic acute subdural hemorrhage
I62.02 Nontraumatic subacute subdural hemorrhage
I62.03 Nontraumatic chronic subdural hemorrhage
I62.1 Nontraumatic extradural hemorrhage
I62.9 Nontraumatic intracranial hemorrhage, unspecified
I63.00 Cerebral infarction due to thrombosis of unspecified precerebral artery
I63.011 Cerebral infarction due to thrombosis of right vertebral artery
I63.012 Cerebral infarction due to thrombosis of left vertebral artery
I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries
I63.02 Cerebral infarction due to thrombosis of basilar artery
I63.031 Cerebral infarction due to thrombosis of right carotid artery
I63.032 Cerebral infarction due to thrombosis of left carotid artery
I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries
I63.09 Cerebral infarction due to thrombosis of other precerebral artery
I63.10 Cerebral infarction due to embolism of unspecified precerebral artery
I63.111 Cerebral infarction due to embolism of right vertebral artery
I63.112 Cerebral infarction due to embolism of left vertebral artery
I63.113 Cerebral infarction due to embolism of bilateral vertebral arteries
I63.12 Cerebral infarction due to embolism of basilar artery
I63.131 Cerebral infarction due to embolism of right carotid artery
I63.132 Cerebral infarction due to embolism of left carotid artery
I63.133 Cerebral infarction due to embolism of bilateral carotid arteries
I63.19 Cerebral infarction due to embolism of other precerebral artery
I63.20 Cerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries
I63.211 Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery
I63.212 Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery
I63.213 Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries
I63.22 Cerebral infarction due to unspecified occlusion or stenosis of basilar artery
I63.231 Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries
I63.233 Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries
I63.29 Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries
I63.30 Cerebral infarction due to thrombosis of unspecified cerebral artery
I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery
I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries
I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries
I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries
I63.341 Cerebral infarction due to thrombosis of right cerebellar artery
I63.342 Cerebral infarction due to thrombosis of left cerebellar artery
I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries
I63.39 Cerebral infarction due to thrombosis of other cerebral artery
I63.40 Cerebral infarction due to embolism of unspecified cerebral artery
I63.411 Cerebral infarction due to embolism of right middle cerebral artery
I63.412 Cerebral infarction due to embolism of left middle cerebral artery
I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries
I63.421 Cerebral infarction due to embolism of right anterior cerebral artery
I63.422 Cerebral infarction due to embolism of left anterior cerebral artery
I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries
I63.431 Cerebral infarction due to embolism of right posterior cerebral artery
I63.432 Cerebral infarction due to embolism of left posterior cerebral artery
I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries
I63.441 Cerebral infarction due to embolism of right cerebellar artery
I63.442 Cerebral infarction due to embolism of left cerebellar artery
I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries
I63.449 Cerebral infarction due to embolism of unspecified cerebellar artery
I63.49 Cerebral infarction due to embolism of other cerebral artery
I63.50 Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery
I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.513 Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries
I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.523 Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries
I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.533 Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries
I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries
I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction
I63.9 Cerebral infarction, unspecified
I65.01 Occlusion and stenosis of right vertebral artery
I65.02 Occlusion and stenosis of left vertebral artery
I65.03 Occlusion and stenosis of bilateral vertebral arteries
I65.1 Occlusion and stenosis of basilar artery
I65.21 Occlusion and stenosis of right carotid artery
I65.22 Occlusion and stenosis of left carotid artery
I65.23 Occlusion and stenosis of bilateral carotid arteries
I65.8 Occlusion and stenosis of other precerebral arteries
I66.01 Occlusion and stenosis of right middle cerebral artery
I66.02 Occlusion and stenosis of left middle cerebral artery
I66.03 Occlusion and stenosis of bilateral middle cerebral arteries
I66.11 Occlusion and stenosis of right anterior cerebral artery
I66.12 Occlusion and stenosis of left anterior cerebral artery
I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries
I66.21 Occlusion and stenosis of right posterior cerebral artery
I66.22 Occlusion and stenosis of left posterior cerebral artery
I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries
I66.3 Occlusion and stenosis of cerebellar arteries
I66.8 Occlusion and stenosis of other cerebral arteries
I66.9 Occlusion and stenosis of unspecified cerebral artery
I67.0 Dissection of cerebral arteries, nonruptured
I67.1 Cerebral aneurysm, nonruptured
I67.5 Moyamoya disease
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
I71.010 Dissection of ascending aorta
I71.011 Dissection of aortic arch
I71.012 Dissection of descending thoracic aorta
I71.019 Dissection of thoracic aorta, unspecified
I71.02 Dissection of abdominal aorta
I71.03 Dissection of thoracoabdominal aorta
I71.10 Thoracic aortic aneurysm, ruptured, unspecified
I71.11 Aneurysm of the ascending aorta, ruptured
I71.12 Aneurysm of the aortic arch, ruptured
I71.13 Aneurysm of the descending thoracic aorta, ruptured
I71.20 Thoracic aortic aneurysm, without rupture, unspecified
I71.21 Aneurysm of the ascending aorta, without rupture
I71.22 Aneurysm of the aortic arch, without rupture
I71.23 Aneurysm of the descending thoracic aorta, without rupture
I71.30 Abdominal aortic aneurysm, ruptured, unspecified
I71.31 Pararenal abdominal aortic aneurysm, ruptured
I71.32 Juxtarenal abdominal aortic aneurysm, ruptured
I71.33 Infrarenal abdominal aortic aneurysm, ruptured
I71.40 Abdominal aortic aneurysm, without rupture, unspecified
I71.41 Pararenal abdominal aortic aneurysm, without rupture
I71.42 Juxtarenal abdominal aortic aneurysm, without rupture
I71.43 Infrarenal abdominal aortic aneurysm, without rupture
I71.50 Thoracoabdominal aortic aneurysm, ruptured, unspecified
I71.51 Supraceliac aneurysm of the thoracoabdominal aorta, ruptured
I71.52 Paravisceral aneurysm of the thoracoabdominal aorta, ruptured
I71.60 Thoracoabdominal aortic aneurysm, without rupture, unspecified
I71.61 Supraceliac aneurysm of the thoracoabdominal aorta, without rupture
I71.62 Paravisceral aneurysm of the thoracoabdominal aorta, without rupture
I77.71 Dissection of carotid artery
I77.74 Dissection of vertebral artery
I77.79 Dissection of other specified artery
I79.0 Aneurysm of aorta in diseases classified elsewhere
M40.03 Postural kyphosis, cervicothoracic region
M40.04 Postural kyphosis, thoracic region
M40.05 Postural kyphosis, thoracolumbar region
M40.12 Other secondary kyphosis, cervical region
M40.13 Other secondary kyphosis, cervicothoracic region
M40.14 Other secondary kyphosis, thoracic region
M40.15 Other secondary kyphosis, thoracolumbar region
M40.202 Unspecified kyphosis, cervical region
M40.203 Unspecified kyphosis, cervicothoracic region
M40.204 Unspecified kyphosis, thoracic region
M40.205 Unspecified kyphosis, thoracolumbar region
M40.292 Other kyphosis, cervical region
M40.293 Other kyphosis, cervicothoracic region
M40.294 Other kyphosis, thoracic region
M40.295 Other kyphosis, thoracolumbar region
M40.35 Flatback syndrome, thoracolumbar region
M40.36 Flatback syndrome, lumbar region
M40.37 Flatback syndrome, lumbosacral region
M40.45 Postural lordosis, thoracolumbar region
M40.46 Postural lordosis, lumbar region
M40.47 Postural lordosis, lumbosacral region
M40.55 Lordosis, unspecified, thoracolumbar region
M40.56 Lordosis, unspecified, lumbar region
M40.57 Lordosis, unspecified, lumbosacral region
M41.02 Infantile idiopathic scoliosis, cervical region
M41.03 Infantile idiopathic scoliosis, cervicothoracic region
M41.04 Infantile idiopathic scoliosis, thoracic region
M41.05 Infantile idiopathic scoliosis, thoracolumbar region
M41.06 Infantile idiopathic scoliosis, lumbar region
M41.07 Infantile idiopathic scoliosis, lumbosacral region
M41.08 Infantile idiopathic scoliosis, sacral and sacrococcygeal region
M41.112 Juvenile idiopathic scoliosis, cervical region
M41.113 Juvenile idiopathic scoliosis, cervicothoracic region
M41.114 Juvenile idiopathic scoliosis, thoracic region
M41.115 Juvenile idiopathic scoliosis, thoracolumbar region
M41.116 Juvenile idiopathic scoliosis, lumbar region
M41.117 Juvenile idiopathic scoliosis, lumbosacral region
M41.122 Adolescent idiopathic scoliosis, cervical region
M41.123 Adolescent idiopathic scoliosis, cervicothoracic region
M41.124 Adolescent idiopathic scoliosis, thoracic region
M41.125 Adolescent idiopathic scoliosis, thoracolumbar region
M41.126 Adolescent idiopathic scoliosis, lumbar region
M41.127 Adolescent idiopathic scoliosis, lumbosacral region
M41.22 Other idiopathic scoliosis, cervical region
M41.23 Other idiopathic scoliosis, cervicothoracic region
M41.24 Other idiopathic scoliosis, thoracic region
M41.25 Other idiopathic scoliosis, thoracolumbar region
M41.26 Other idiopathic scoliosis, lumbar region
M41.27 Other idiopathic scoliosis, lumbosacral region
M41.34 Thoracogenic scoliosis, thoracic region
M41.35 Thoracogenic scoliosis, thoracolumbar region
M41.41 Neuromuscular scoliosis, occipito-atlanto-axial region
M41.42 Neuromuscular scoliosis, cervical region
M41.43 Neuromuscular scoliosis, cervicothoracic region
M41.44 Neuromuscular scoliosis, thoracic region
M41.45 Neuromuscular scoliosis, thoracolumbar region
M41.46 Neuromuscular scoliosis, lumbar region
M41.47 Neuromuscular scoliosis, lumbosacral region
M41.52 Other secondary scoliosis, cervical region
M41.53 Other secondary scoliosis, cervicothoracic region
M41.54 Other secondary scoliosis, thoracic region
M41.55 Other secondary scoliosis, thoracolumbar region
M41.56 Other secondary scoliosis, lumbar region
M41.57 Other secondary scoliosis, lumbosacral region
M41.82 Other forms of scoliosis, cervical region
M41.83 Other forms of scoliosis, cervicothoracic region
M41.84 Other forms of scoliosis, thoracic region
M41.85 Other forms of scoliosis, thoracolumbar region
M41.86 Other forms of scoliosis, lumbar region
M41.87 Other forms of scoliosis, lumbosacral region
M43.8X1 Other specified deforming dorsopathies, occipito-atlanto-axial region
M43.8X2 Other specified deforming dorsopathies, cervical region
M43.8X3 Other specified deforming dorsopathies, cervicothoracic region
M43.8X4 Other specified deforming dorsopathies, thoracic region
M43.8X5 Other specified deforming dorsopathies, thoracolumbar region
M43.8X6 Other specified deforming dorsopathies, lumbar region
M43.8X7 Other specified deforming dorsopathies, lumbosacral region
M43.8X8 Other specified deforming dorsopathies, sacral and sacrococcygeal region
M47.011 Anterior spinal artery compression syndromes, occipito-atlanto-axial region
M47.012 Anterior spinal artery compression syndromes, cervical region
M47.013 Anterior spinal artery compression syndromes, cervicothoracic region
M47.014 Anterior spinal artery compression syndromes, thoracic region
M47.015 Anterior spinal artery compression syndromes, thoracolumbar region
M47.016 Anterior spinal artery compression syndromes, lumbar region
M47.021 Vertebral artery compression syndromes, occipito-atlanto-axial region
M47.022 Vertebral artery compression syndromes, cervical region
M47.11 Other spondylosis with myelopathy, occipito-atlanto-axial region
M47.12 Other spondylosis with myelopathy, cervical region
M47.13 Other spondylosis with myelopathy, cervicothoracic region
M47.14 Other spondylosis with myelopathy, thoracic region
M47.15 Other spondylosis with myelopathy, thoracolumbar region
M47.16 Other spondylosis with myelopathy, lumbar region
M50.01 Cervical disc disorder with myelopathy, high cervical region
M50.020 Cervical disc disorder with myelopathy, mid-cervical region, unspecified level
M50.021 Cervical disc disorder at C4-C5 level with myelopathy
M50.022 Cervical disc disorder at C5-C6 level with myelopathy
M50.023 Cervical disc disorder at C6-C7 level with myelopathy
M50.03 Cervical disc disorder with myelopathy, cervicothoracic region
M51.04 Intervertebral disc disorders with myelopathy, thoracic region
M51.05 Intervertebral disc disorders with myelopathy, thoracolumbar region
M51.06 Intervertebral disc disorders with myelopathy, lumbar region
M51.9 Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder
M96.2 Postradiation kyphosis
M96.3 Postlaminectomy kyphosis
M96.4 Postsurgical lordosis
M96.5 Postradiation scoliosis
P11.3 Birth injury to facial nerve
P11.4 Birth injury to other cranial nerves
P11.5 Birth injury to spine and spinal cord
P14.0 Erb's paralysis due to birth injury
P14.1 Klumpke's paralysis due to birth injury
P14.2 Phrenic nerve paralysis due to birth injury
P14.3 Other brachial plexus birth injuries
P14.8 Birth injuries to other parts of peripheral nervous system
Q05.0 Cervical spina bifida with hydrocephalus
Q05.1 Thoracic spina bifida with hydrocephalus
Q05.2 Lumbar spina bifida with hydrocephalus
Q05.3 Sacral spina bifida with hydrocephalus
Q05.5 Cervical spina bifida without hydrocephalus
Q05.6 Thoracic spina bifida without hydrocephalus
Q05.7 Lumbar spina bifida without hydrocephalus
Q05.8 Sacral spina bifida without hydrocephalus
Q07.00 Arnold-Chiari syndrome without spina bifida or hydrocephalus
Q07.01 Arnold-Chiari syndrome with spina bifida
Q07.02 Arnold-Chiari syndrome with hydrocephalus
Q07.03 Arnold-Chiari syndrome with spina bifida and hydrocephalus
Q27.9 Congenital malformation of peripheral vascular system, unspecified
Q28.2 Arteriovenous malformation of cerebral vessels
Q28.3 Other malformations of cerebral vessels
Q85.00 Neurofibromatosis, unspecified
Q85.01 Neurofibromatosis, type 1
Q85.02 Neurofibromatosis, type 2
Q85.03 Schwannomatosis
Q85.09 Other neurofibromatosis

Group 2

(215 Codes)
Group 2 Paragraph

Coverage for this group of codes includes any of the 7th digits that apply to these codes; A, B, D, G, K, P, or S.

Group 2 Codes
Code Description
M48.41XA Fatigue fracture of vertebra, occipito-atlanto-axial region, initial encounter for fracture
M48.42XA Fatigue fracture of vertebra, cervical region, initial encounter for fracture
M48.43XA Fatigue fracture of vertebra, cervicothoracic region, initial encounter for fracture
M48.44XA Fatigue fracture of vertebra, thoracic region, initial encounter for fracture
M48.45XA Fatigue fracture of vertebra, thoracolumbar region, initial encounter for fracture
M48.46XA Fatigue fracture of vertebra, lumbar region, initial encounter for fracture
M48.47XA Fatigue fracture of vertebra, lumbosacral region, initial encounter for fracture
M48.48XA Fatigue fracture of vertebra, sacral and sacrococcygeal region, initial encounter for fracture
M48.51XA Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, initial encounter for fracture
M48.52XA Collapsed vertebra, not elsewhere classified, cervical region, initial encounter for fracture
M48.53XA Collapsed vertebra, not elsewhere classified, cervicothoracic region, initial encounter for fracture
M48.54XA Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture
M48.55XA Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for fracture
M48.56XA Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture
M48.57XA Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture
M48.58XA Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, initial encounter for fracture
M80.08XA Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.0B1A Age-related osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture
M80.0B1D Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing
M80.0B1G Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing
M80.0B1K Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion
M80.0B1P Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion
M80.0B1S Age-related osteoporosis with current pathological fracture, right pelvis, sequela
M80.0B2A Age-related osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture
M80.0B2D Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing
M80.0B2G Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing
M80.0B2K Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion
M80.0B2P Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion
M80.0B2S Age-related osteoporosis with current pathological fracture, left pelvis, sequela
M80.0B9A Age-related osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture
M80.0B9D Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with routine healing
M80.0B9G Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with delayed healing
M80.0B9K Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with nonunion
M80.0B9P Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with malunion
M80.0B9S Age-related osteoporosis with current pathological fracture, unspecified pelvis, sequela
M80.88XA Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.8B1A Other osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture
M80.8B1D Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing
M80.8B1G Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing
M80.8B1K Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion
M80.8B1P Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion
M80.8B1S Other osteoporosis with current pathological fracture, right pelvis, sequela
M80.8B2A Other osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture
M80.8B2D Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing
M80.8B2G Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing
M80.8B2K Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion
M80.8B2P Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion
M80.8B2S Other osteoporosis with current pathological fracture, left pelvis, sequela
M80.8B9A Other osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture
M80.8B9D Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with routine healing
M80.8B9G Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with delayed healing
M80.8B9K Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with nonunion
M80.8B9P Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with malunion
M80.8B9S Other osteoporosis with current pathological fracture, unspecified pelvis, sequela
M84.58XA Pathological fracture in neoplastic disease, other specified site, initial encounter for fracture
M84.68XA Pathological fracture in other disease, other site, initial encounter for fracture
S12.000A Unspecified displaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.001A Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.01XA Stable burst fracture of first cervical vertebra, initial encounter for closed fracture
S12.02XA Unstable burst fracture of first cervical vertebra, initial encounter for closed fracture
S12.030A Displaced posterior arch fracture of first cervical vertebra, initial encounter for closed fracture
S12.031A Nondisplaced posterior arch fracture of first cervical vertebra, initial encounter for closed fracture
S12.040A Displaced lateral mass fracture of first cervical vertebra, initial encounter for closed fracture
S12.041A Nondisplaced lateral mass fracture of first cervical vertebra, initial encounter for closed fracture
S12.090A Other displaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.091A Other nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.100A Unspecified displaced fracture of second cervical vertebra, initial encounter for closed fracture
S12.101A Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture
S12.110A Anterior displaced Type II dens fracture, initial encounter for closed fracture
S12.111A Posterior displaced Type II dens fracture, initial encounter for closed fracture
S12.112A Nondisplaced Type II dens fracture, initial encounter for closed fracture
S12.120A Other displaced dens fracture, initial encounter for closed fracture
S12.121A Other nondisplaced dens fracture, initial encounter for closed fracture
S12.130A Unspecified traumatic displaced spondylolisthesis of second cervical vertebra, initial encounter for closed fracture
S12.131A Unspecified traumatic nondisplaced spondylolisthesis of second cervical vertebra, initial encounter for closed fracture
S12.14XA Type III traumatic spondylolisthesis of second cervical vertebra, initial encounter for closed fracture
S12.150A Other traumatic displaced spondylolisthesis of second cervical vertebra, initial encounter for closed fracture
S12.151A Other traumatic nondisplaced spondylolisthesis of second cervical vertebra, initial encounter for closed fracture
S12.190A Other displaced fracture of second cervical vertebra, initial encounter for closed fracture
S12.191A Other nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture
S12.200A Unspecified displaced fracture of third cervical vertebra, initial encounter for closed fracture
S12.201A Unspecified nondisplaced fracture of third cervical vertebra, initial encounter for closed fracture
S12.230A Unspecified traumatic displaced spondylolisthesis of third cervical vertebra, initial encounter for closed fracture
S12.231A Unspecified traumatic nondisplaced spondylolisthesis of third cervical vertebra, initial encounter for closed fracture
S12.24XA Type III traumatic spondylolisthesis of third cervical vertebra, initial encounter for closed fracture
S12.250A Other traumatic displaced spondylolisthesis of third cervical vertebra, initial encounter for closed fracture
S12.251A Other traumatic nondisplaced spondylolisthesis of third cervical vertebra, initial encounter for closed fracture
S12.290A Other displaced fracture of third cervical vertebra, initial encounter for closed fracture
S12.291A Other nondisplaced fracture of third cervical vertebra, initial encounter for closed fracture
S12.300A Unspecified displaced fracture of fourth cervical vertebra, initial encounter for closed fracture
S12.301A Unspecified nondisplaced fracture of fourth cervical vertebra, initial encounter for closed fracture
S12.330A Unspecified traumatic displaced spondylolisthesis of fourth cervical vertebra, initial encounter for closed fracture
S12.331A Unspecified traumatic nondisplaced spondylolisthesis of fourth cervical vertebra, initial encounter for closed fracture
S12.34XA Type III traumatic spondylolisthesis of fourth cervical vertebra, initial encounter for closed fracture
S12.350A Other traumatic displaced spondylolisthesis of fourth cervical vertebra, initial encounter for closed fracture
S12.351A Other traumatic nondisplaced spondylolisthesis of fourth cervical vertebra, initial encounter for closed fracture
S12.390A Other displaced fracture of fourth cervical vertebra, initial encounter for closed fracture
S12.391A Other nondisplaced fracture of fourth cervical vertebra, initial encounter for closed fracture
S12.400A Unspecified displaced fracture of fifth cervical vertebra, initial encounter for closed fracture
S12.401A Unspecified nondisplaced fracture of fifth cervical vertebra, initial encounter for closed fracture
S12.430A Unspecified traumatic displaced spondylolisthesis of fifth cervical vertebra, initial encounter for closed fracture
S12.431A Unspecified traumatic nondisplaced spondylolisthesis of fifth cervical vertebra, initial encounter for closed fracture
S12.44XA Type III traumatic spondylolisthesis of fifth cervical vertebra, initial encounter for closed fracture
S12.450A Other traumatic displaced spondylolisthesis of fifth cervical vertebra, initial encounter for closed fracture
S12.451A Other traumatic nondisplaced spondylolisthesis of fifth cervical vertebra, initial encounter for closed fracture
S12.490A Other displaced fracture of fifth cervical vertebra, initial encounter for closed fracture
S12.491A Other nondisplaced fracture of fifth cervical vertebra, initial encounter for closed fracture
S12.500A Unspecified displaced fracture of sixth cervical vertebra, initial encounter for closed fracture
S12.501A Unspecified nondisplaced fracture of sixth cervical vertebra, initial encounter for closed fracture
S12.530A Unspecified traumatic displaced spondylolisthesis of sixth cervical vertebra, initial encounter for closed fracture
S12.531A Unspecified traumatic nondisplaced spondylolisthesis of sixth cervical vertebra, initial encounter for closed fracture
S12.54XA Type III traumatic spondylolisthesis of sixth cervical vertebra, initial encounter for closed fracture
S12.550A Other traumatic displaced spondylolisthesis of sixth cervical vertebra, initial encounter for closed fracture
S12.551A Other traumatic nondisplaced spondylolisthesis of sixth cervical vertebra, initial encounter for closed fracture
S12.590A Other displaced fracture of sixth cervical vertebra, initial encounter for closed fracture
S12.591A Other nondisplaced fracture of sixth cervical vertebra, initial encounter for closed fracture
S12.600A Unspecified displaced fracture of seventh cervical vertebra, initial encounter for closed fracture
S12.601A Unspecified nondisplaced fracture of seventh cervical vertebra, initial encounter for closed fracture
S12.630A Unspecified traumatic displaced spondylolisthesis of seventh cervical vertebra, initial encounter for closed fracture
S12.631A Unspecified traumatic nondisplaced spondylolisthesis of seventh cervical vertebra, initial encounter for closed fracture
S12.64XA Type III traumatic spondylolisthesis of seventh cervical vertebra, initial encounter for closed fracture
S12.650A Other traumatic displaced spondylolisthesis of seventh cervical vertebra, initial encounter for closed fracture
S12.651A Other traumatic nondisplaced spondylolisthesis of seventh cervical vertebra, initial encounter for closed fracture
S12.690A Other displaced fracture of seventh cervical vertebra, initial encounter for closed fracture
S12.691A Other nondisplaced fracture of seventh cervical vertebra, initial encounter for closed fracture
S14.2XXA Injury of nerve root of cervical spine, initial encounter
S14.3XXA Injury of brachial plexus, initial encounter
S22.010A Wedge compression fracture of first thoracic vertebra, initial encounter for closed fracture
S22.011A Stable burst fracture of first thoracic vertebra, initial encounter for closed fracture
S22.012A Unstable burst fracture of first thoracic vertebra, initial encounter for closed fracture
S22.018A Other fracture of first thoracic vertebra, initial encounter for closed fracture
S22.019A Unspecified fracture of first thoracic vertebra, initial encounter for closed fracture
S22.020A Wedge compression fracture of second thoracic vertebra, initial encounter for closed fracture
S22.021A Stable burst fracture of second thoracic vertebra, initial encounter for closed fracture
S22.022A Unstable burst fracture of second thoracic vertebra, initial encounter for closed fracture
S22.028A Other fracture of second thoracic vertebra, initial encounter for closed fracture
S22.029A Unspecified fracture of second thoracic vertebra, initial encounter for closed fracture
S22.030A Wedge compression fracture of third thoracic vertebra, initial encounter for closed fracture
S22.031A Stable burst fracture of third thoracic vertebra, initial encounter for closed fracture
S22.032A Unstable burst fracture of third thoracic vertebra, initial encounter for closed fracture
S22.038A Other fracture of third thoracic vertebra, initial encounter for closed fracture
S22.039A Unspecified fracture of third thoracic vertebra, initial encounter for closed fracture
S22.040A Wedge compression fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.041A Stable burst fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.042A Unstable burst fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.048A Other fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.049A Unspecified fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.050A Wedge compression fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.051A Stable burst fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.052A Unstable burst fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.058A Other fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.059A Unspecified fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.060A Wedge compression fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.061A Stable burst fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.062A Unstable burst fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.068A Other fracture of T7-T8 thoracic vertebra, initial encounter for closed fracture
S22.069A Unspecified fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.070A Wedge compression fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.071A Stable burst fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.072A Unstable burst fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.078A Other fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.079A Unspecified fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.080A Wedge compression fracture of T11-T12 vertebra, initial encounter for closed fracture
S22.081A Stable burst fracture of T11-T12 vertebra, initial encounter for closed fracture
S22.082A Unstable burst fracture of T11-T12 vertebra, initial encounter for closed fracture
S22.088A Other fracture of T11-T12 vertebra, initial encounter for closed fracture
S22.089A Unspecified fracture of T11-T12 vertebra, initial encounter for closed fracture
S24.2XXA Injury of nerve root of thoracic spine, initial encounter
S32.010A Wedge compression fracture of first lumbar vertebra, initial encounter for closed fracture
S32.011A Stable burst fracture of first lumbar vertebra, initial encounter for closed fracture
S32.012A Unstable burst fracture of first lumbar vertebra, initial encounter for closed fracture
S32.018A Other fracture of first lumbar vertebra, initial encounter for closed fracture
S32.019A Unspecified fracture of first lumbar vertebra, initial encounter for closed fracture
S32.020A Wedge compression fracture of second lumbar vertebra, initial encounter for closed fracture
S32.021A Stable burst fracture of second lumbar vertebra, initial encounter for closed fracture
S32.022A Unstable burst fracture of second lumbar vertebra, initial encounter for closed fracture
S32.028A Other fracture of second lumbar vertebra, initial encounter for closed fracture
S32.029A Unspecified fracture of second lumbar vertebra, initial encounter for closed fracture
S32.030A Wedge compression fracture of third lumbar vertebra, initial encounter for closed fracture
S32.031A Stable burst fracture of third lumbar vertebra, initial encounter for closed fracture
S32.032A Unstable burst fracture of third lumbar vertebra, initial encounter for closed fracture
S32.038A Other fracture of third lumbar vertebra, initial encounter for closed fracture
S32.039A Unspecified fracture of third lumbar vertebra, initial encounter for closed fracture
S32.040A Wedge compression fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.041A Stable burst fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.042A Unstable burst fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.048A Other fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.049A Unspecified fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.050A Wedge compression fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.051A Stable burst fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.052A Unstable burst fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.058A Other fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.059A Unspecified fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.10XA Unspecified fracture of sacrum, initial encounter for closed fracture
S32.110A Nondisplaced Zone I fracture of sacrum, initial encounter for closed fracture
S32.111A Minimally displaced Zone I fracture of sacrum, initial encounter for closed fracture
S32.112A Severely displaced Zone I fracture of sacrum, initial encounter for closed fracture
S32.119A Unspecified Zone I fracture of sacrum, initial encounter for closed fracture
S32.120A Nondisplaced Zone II fracture of sacrum, initial encounter for closed fracture
S32.121A Minimally displaced Zone II fracture of sacrum, initial encounter for closed fracture
S32.122A Severely displaced Zone II fracture of sacrum, initial encounter for closed fracture
S32.129A Unspecified Zone II fracture of sacrum, initial encounter for closed fracture
S32.130A Nondisplaced Zone III fracture of sacrum, initial encounter for closed fracture
S32.131A Minimally displaced Zone III fracture of sacrum, initial encounter for closed fracture
S32.132A Severely displaced Zone III fracture of sacrum, initial encounter for closed fracture
S32.139A Unspecified Zone III fracture of sacrum, initial encounter for closed fracture
S32.14XA Type 1 fracture of sacrum, initial encounter for closed fracture
S32.15XA Type 2 fracture of sacrum, initial encounter for closed fracture
S32.16XA Type 3 fracture of sacrum, initial encounter for closed fracture
S32.17XA Type 4 fracture of sacrum, initial encounter for closed fracture
S32.19XA Other fracture of sacrum, initial encounter for closed fracture
S32.2XXA Fracture of coccyx, initial encounter for closed fracture
S34.21XA Injury of nerve root of lumbar spine, initial encounter
S34.22XA Injury of nerve root of sacral spine, initial encounter
S34.4XXA Injury of lumbosacral plexus, initial encounter
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
02/01/2024 R6

02/01/2024: Biannual review completed with no change in coverage.

10/01/2023 R5

Posted 09/28/2023: Under ICD-10 Codes that Meet Medical Necessity Group 1 Codes the following codes had description changes: I71.51, I71.52, I71.61, I71.62. Under ICD-10 Codes that Meet Medical Necessity Group 2 Codes added the following codes due the 2024 Annual ICD-10-CM Update: M80.0B1A, M80.0B1D, M80.0B1G, M80.0B1K, M80.0B1P, M80.0B1S, M80.0B2A, M80.0B2D, M80.0B2G, M80.0B2K, M80.0B2P, M80.0B2S, M80.0B9A, M80.0B9D, M80.0B9G, M80.0B9K, M80.0B9P, M80.0B9S, M80.8B1A, M80.8B1D, M80.8B1G, M80.8B1K, M80.8B1P, M80.8B1S, M80.8B2A, M80.8B2D, M80.8B2G, M80.8B2K, M80.8B2P, M80.8B2S, M80.8B9A, M80.8B9D, M80.8B9G, M80.8B9K, M80.8B9P, and M80.8B9S.

10/01/2022 R4

Posted 09/29/2022: ICD-10-CM Code Updates: Under ICD-10 Codes that Support Medical Necessity, deleted I71.01, I71.1, I71.2, I71.3, I71.4, I71.5, and I71.6 from Group 1 Codes. Added the following to Group 1 Codes: I71.010, I71.011, I71.012, I71.019, I71.10, I71.11, I71.12, I71.13, I71.20, I71.21, I71.22, I71.23, I71.30, I71.31, I71.32, I71.33, I71.40, I71.41, I71.42, I71.43, I71.50, I71.51, I71.52, I71.60, I71.61, and I71.62.

07/28/2022 R3

Posted 07/28/2022: Minor typographical errors corrected throughout the article. Review completed 06/30/2022 with no change in coverage.

10/01/2020 R2

10/01/2020 Format revision completed: Added “P” to appropriate 7th character for Group 2 Paragraph ICD-10 Code. No change in coverage.

07/30/2020 R1

07/30/2020 Added to Article Guidance: L34623 Intraoperative Neurophysiological Testing. Review completed 07/07/2020 with no change in coverage.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34623 - Intraoperative Neurophysiological Testing
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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CMS Manual Explanations URLs
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