ICD-10 M54.13 is officially defined as "Radiculopathy, cervicothoracic region." code M54.13 is referenced in 5 tracked payer policy changes from Health Net, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code M54.13 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
CalViva Health updated multiple medical policies for Q1 2020, affecting prior authorization requirements, coverage criteria, and billing codes across numerous specialties. Key changes include new coronavirus testing guidelines, updated DME criteria, revised surgical procedure coverage, and modified prior authorization requirements for various treatments.
Health Net updated multiple medical policies in Q1 2020, including new prior authorization requirements, coverage changes for various procedures, and updated billing codes. Key changes include new coronavirus testing guidelines, revised DME criteria, and updated coverage for procedures like facet joint injections and nerve blocks.
Health Net updated multiple medical policies for Q1 2020, including new COVID-19 testing guidelines, changes to prior authorization requirements for various procedures, and updates to coverage criteria for DME, nerve blocks, transplants, and other services. Most notably, several procedures were reclassified as not medically necessary or investigational, affecting billing and coverage.
Aetna's Clinical Policy Bulletin 0743 sets medical necessity criteria for cervical, thoracic and lumbar laminectomy, laminoplasty, spinal fusion, vertebral corpectomy, and removal of spinal instrumentation. Most covered indications require advanced imaging (CT or MRI) showing at least moderate central, lateral recess or foraminal stenosis, or nerve root or spinal cord compression, at the level matching the clinical findings, and failure of at least 6 weeks of conservative therapy, or 3 months for certain fusion indications such as scoliosis, kyphosis and sub-axial instability. Computer-assisted surgical navigation is approvable only when fusion implants are placed during surgery, and it is not approvable during routine decompression surgery.
Epidural steroid injections may be considered medically necessary as treatment of cervical or lumbar radiculopathy. Reimbursement is limited to a series of three injections in a calendar year at any one level under any and all circumstances. The policy was reviewed on 01/14/2026 with its policy statements unchanged, and ICD-9 procedure and diagnosis codes were removed from the code reference.
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