Does M86.321 require prior authorization?

No, M86.321 does not require prior authorization (low confidence). No active coverage policies found for this code.

`M86.321`, Chronic multifocal osteomyelitis, right humerus

ICD-10-CM

No Prior Auth Required

No active coverage policies found for this code (low confidence)

The patient’s medical record must include the ordering provider’s assessment as it relates to the patient’s complaint for that visit.
Medical records must contain relevant medical history and results of pertinent tests or procedures performed.
For diagnostic tests, report the result of the test if known; otherwise report the symptoms that prompted performing the test.
All services ordered or rendered to Medicare beneficiaries must be signed and dated; include a signed and dated office visit record or operative report in the medical record.

A valid ICD-10-CM diagnosis code that best describes the patient’s condition for which the debridement service was performed must be reported on the claim.
When a service requires a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
No specific clinical indications are provided in this billing and coding article; coverage criteria for amniotic and placental-derived product injections/applications for musculoskeletal non-wound indications are described in Local Coverage Determination L39116.
Coverage for amniotic and placental-derived product injections/applications for musculoskeletal, non-wound indications is determined by Local Coverage Determination L39139; consult LCD L39139 for specific clinical indications and thresholds.
PET scan is covered to evaluate fever of unknown origin when there is a documented fever curve with temperatures, at least 21 days since fever onset, and documented fevers within the two weeks prior to the PET study.
Coverage applies when the amniotic or placental-derived product injection/application meets the reasonable and necessary requirements of Local Coverage Determination L39877.

CGS-J15-L34032, Debridement Services

J15

CGS-J15-L39521, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J15

CGS-J18-L34032, Debridement Services

J18

CGS-J18-L39521, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J18

Ask Backwork about documentation requirements, denial risks, or coverage in your state.