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Indications for Medical Necessity

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(Check options which applies to patient).

  • Used therapeutically to help realign the spinal cord and relieve pain

  • Soft Tissue Injuries

  • Post-Surgical Stabilization

  • For strains, sprains or whiplash

  • Cervical Disc Syndrome

  • Cervicogenic Pain

  • To help healing process

  • Radiculopathy

  • Fracture Management

  • Neuropathy

  • Reduce the symptoms of Forward Head Carriage

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Clinical Note Requirements: Dictation must be exactly as shown above for the indication chosen.

Cervical Collar Indications for Prescribed PT:

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Collar

L0180

Most common ICD-10 codes:

M47.812 - Spondylosis without myelopathy or radiculopathy

M48.02 - Spinal stenosis, cervical region

M50.00 - Cervical disc disorder with myelopathy

M50.10 - Cervical disc disorder with radiculopathy, unspecified cervical region

M50.20 - Other cervical disc displacement

M50.30 - Other cervical disc degeneration

M54.2 - Cervicalgia

M54.12 Radiculopathy, cervical region

S13.4XXA - Sprain of ligaments of cervical spine, initial encounter

RX/DWO

Cervical Collar Document Requirements: Signed/Dated RX, Clinicals with Indications. Up to date patient demographics with insurance information.

Cervical Bone Growth Stimulator for Prescribed PT:

(Must select one of the following):
⃝     Failed spinal fusion (ICD-10 code Z98.1) where a minimum of nine months has elapsed since the last surgery.
⃝     Following a multilevel spinal fusion surgery (ICD-10 code Z98.1).
⃝     Following spinal fusion surgery (ICD-10 code Z98.1) where there is a history of a previously failed spinal fusion at the same site.

 

Clinical Requirements: Must be Multi-Level Fusion. No single level fusion approvals. 

Cervical Bone Growth Stimulator

E0748

Most common ICD-10 codes:

Z98.1- Arthrodesis status

M47.812 - Spondylosis without myelopathy or radiculopathy

M48.02 - Spinal stenosis, cervical region

M50.00 - Cervical disc disorder with myelopathy

M50.10 - Cervical disc disorder with radiculopathy, unspecified cervical region

M50.20 - Other cervical disc displacement

M50.30 - Other cervical disc degeneration

M54.2 - Cervicalgia

M54.12 Radiculopathy, cervical region

S13.4XXA - Sprain of ligaments of cervical spine, initial encounter

Requires CMN

Bone Growth Stimulator Document Requirements: Signed/Dated RX, Clinicals with Indications. Signed/Dated CMN. Up to date patient demographics with insurance information.

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