SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Cervical Disc Replacement

A57021

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Draft Article
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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To see the currently-in-effect version of this document, go to the section.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57021
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Cervical Disc Replacement
Article Type
Billing and Coding
Original Effective Date
10/28/2019
Revision Effective Date
01/01/2024
Revision Ending Date
N/A
Retirement Date
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CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary information to process that claim.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Cervical Disc Replacement L38033.

Response To Comments

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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(20 Codes)
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Group 1 Codes
Code Description
G54.2 Cervical root disorders, not elsewhere classified
G54.9 Nerve root and plexus disorder, unspecified
M48.02 Spinal stenosis, cervical region
M50.01 Cervical disc disorder with myelopathy, high cervical region
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
M50.11 Cervical disc disorder with radiculopathy, high cervical region
M50.121 Cervical disc disorder at C4-C5 level with radiculopathy
M50.122 Cervical disc disorder at C5-C6 level with radiculopathy
M50.123 Cervical disc disorder at C6-C7 level with radiculopathy
M50.21 Other cervical disc displacement, high cervical region
M50.221 Other cervical disc displacement at C4-C5 level
M50.222 Other cervical disc displacement at C5-C6 level
M50.223 Other cervical disc displacement at C6-C7 level
M50.31 Other cervical disc degeneration, high cervical region
M50.321 Other cervical disc degeneration at C4-C5 level
M50.322 Other cervical disc degeneration at C5-C6 level
M50.323 Other cervical disc degeneration at C6-C7 level
M53.1 Cervicobrachial syndrome
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
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Group 1 Codes
Code Description
Z98.1 Arthrodesis status
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ICD-10-PCS Codes

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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
01/01/2024 R7

Under CPT/HCPCS Codes Group 3: Codes the description was revised for 97032, 97033, 97034, 97035 and 97036 and added 97037. This revision is due to the 2024 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/24.

03/23/2023 R6

Formatting errors were corrected throughout the article.

01/01/2023 R5

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 22856, 22858, and 22861. Under CPT/HCPCS Codes Group 3: Codes the description was revised for 97039 and 97139. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/23.

01/01/2022 R4

Under CPT/HCPCS Codes Group 1: Codes the description was revised for codes 22856 and 22858. This revision is due to the Annual CPT/HCPCS update and is effective on 1/1/22.

06/17/2021 R3

Under CMS National Coverage Policy added regulation Title XVIII of the Social Security Act, §1833(e).

01/01/2021 R2

Under CPT/HCPCS Codes Group 1: Codes the description was revised for code 22861. This revision is due to the Q1 2021 CPT/HCPCS code update and has a retroactive effective date of 1/1/21.

01/01/2020 R1

Under CPT/HCPCS Codes Group 2: Codes deleted CPT® code 0375T. Under CPT/HCPCS Codes Group 3: Codes added CPT® codes 97129 and 97130. CPT® code 97127 was deleted. This revision is due to the Annual CPT®/HCPCS Code Update and becomes effective on 1/1/20.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
01/29/2024 01/01/2024 - N/A Currently in Effect View
12/28/2023 01/01/2024 - N/A Superseded You are here
03/14/2023 03/23/2023 - 12/31/2023 Superseded View
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