Does G97.63 require prior authorization?

No, G97.63 does not require prior authorization (high confidence). Covered without prior authorization.

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`G97.63`, Postprocedural seroma of a nervous system organ or structure following a nervous system procedure

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
No explicit 'Documentation Requirements' section or specific documentation checklist is stated in this Clinical Policy Bulletin

Implicit documentation expected based on policy context: clinical indication consistent with covered indications (e.g., newborn/infant diagnosis or intra-operative need), supporting diagnosis code from the covered ICD-10 list, and documentation of selection criteria for CPT 76800 (note: these are inferred; not explicitly listed in the policy text)

Reimbursement will only be provided if the requested service is submitted in accordance with the relevant guidelines and criteria outlined in this policy, including covered diagnosis and/or procedure code(s) outlined in the Coding Information section of this policy.

Key Coverage Criteria

Covered CPT code if selection criteria are met: 76800 — "Ultrasound, spinal canal and contents"
Ultrasound of the spine and para-spinal tissues is medically necessary in newborns and infants for detection of sequelae of injury (e.g., hematoma after spinal tap or birth injury; post-traumatic leakage of cerebrospinal fluid; and sequelae of prior instrumentation, infection, or hemorrhage)
Ultrasound of the spine and para-spinal tissues is medically necessary in newborns and infants for evaluation of suspected defects such as cord tethering, diastematomyelia, hydromyelia, and syringomyelia
Ultrasound of the spine and para-spinal tissues is medically necessary in newborns and infants for guidance for lumbar puncture
Ultrasound of the spine and para-spinal tissues is medically necessary in newborns and infants for lumbosacral stigmata known to be associated with spinal dysraphism
Ultrasound of the spine and para-spinal tissues is medically necessary when performed intra-operatively

4 Active Policies

CIGNA-CPG038, Spinal Ultrasound

AETNA-CPB-0628, Spinal Ultrasound

A56421, Billing and Coding: CT of the Abdomen and Pelvis

A56612, Billing and Coding: CT of the Head

`G97.63`, Postprocedural seroma of a nervous system organ or structure following a nervous system procedure

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

G97.63, Postprocedural seroma of a nervous system organ or structure following a nervous system procedure

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

`G97.63`, Postprocedural seroma of a nervous system organ or structure following a nervous system procedure