Prior Authorization Module: How to Win the Game and Help Your Patients-Prior Authorization References

Prior Authorization References

Pdf Summary

This document provides references related to prior authorization requirements under Medicare, specifically focusing on electrical nerve stimulators, peripheral nerve and spinal cord stimulation, and facet joint interventions. It includes the National Coverage Determination (NCD) for Electrical Nerve Stimulators (160.7) and various Local Coverage Determinations (LCDs) issued by Medicare Administrative Contractors (MACs).<br /><br />For peripheral nerve and spinal cord stimulation, the document lists LCDs from Noridian (L37360, L36204, L35136) and Palmetto (L37632), which address coverage for chronic pain management using these devices.<br /><br />Regarding facet joint interventions for pain management, multiple LCDs are referenced from different MACs including CGS (L38773), FCSO (L33930), NGS (L35936), Noridian (L38801), Novitas (L34892), Palmetto (L38765), and WPS (L38841). These documents outline the criteria and requirements for coverage of facet joint procedures.<br /><br />Additionally, the document mentions a final list of outpatient department services that require prior authorization under Medicare, emphasizing updated regulations and procedures as of August 7, 2025.<br /><br />Overall, this compilation serves as a resource for healthcare providers and administrators to understand the Medicare prior authorization landscape for specific pain management treatments involving electrical nerve stimulation and facet joint interventions, ensuring compliance with coverage policies and authorization protocols.

Keywords

Medicare prior authorization

electrical nerve stimulators

National Coverage Determination 160.7

Local Coverage Determinations

peripheral nerve stimulation

spinal cord stimulation

facet joint interventions

chronic pain management

Medicare Administrative Contractors

outpatient department services