Does P10.4 require prior authorization?

No, P10.4 does not require prior authorization (high confidence). Covered without prior authorization.

`P10.4`, Tentorial tear due to birth injury

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Spinal and/or paraspinal ultrasound is considered medically necessary in newborns and infants (i.e., <2 years of age) for ANY of the following indications:
detection of sequelae of injury (e.g., hematoma after birth injury, infection or hemorrhage, post-traumatic leakage of cerebral spinal fluid)
evaluation and diagnosis of suspected spinal cord tumors, vascular malformations and birth-related trauma
evaluation of caudal regression syndrome (e.g., anal atresia or stenosis, sacral agenesis)

AMBETTER-CP.VP.06, Medically Necessary Optical Hardware

CIGNA-CPG038, Spinal Ultrasound

A56612, Billing and Coding: CT of the Head

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

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