Does P52.5 require prior authorization?

No, P52.5 does not require prior authorization (high confidence). Code is covered without prior authorization.

`P52.5`, Subarachnoid (nontraumatic) hemorrhage of newborn

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
Providers should check and apply Correct Coding Initiative (CCI) edits and applicable LCD guidance for correct code combinations before billing.

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.
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

ANTHEM-CG-LAB-20, Thyroid Testing

CIGNA-CPG038, Spinal Ultrasound

AETNA-CPB-0628, Spinal Ultrasound

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.