Does P52.9 require prior authorization?

No, P52.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`P52.9`, Intracranial (nontraumatic) hemorrhage of newborn, unspecified

ICD-10-CM

No Prior Auth Required

Code is 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.
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.
When billing, providers must use the most appropriate codes as of the effective date of the submission; claims submitted without covered codes under this policy will be denied as not covered.
Medical necessity documentation must support one of the listed covered indications (e.g., age <2 years for neonatal/infant indications; documentation of intraoperative use when performed during spinal/paraspinal surgery).

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)
evaluation of lumbosacral stigmata known to be associated with spinal dysraphism (e.g., atypical deep sacral dimple >5 mm in diameter within >2.5 cm of the anus)
evaluation of suspected defects (e.g., cord tethering, diastematomyelia, hydromyelia, syringomyelia)

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

CIGNA-CPG038, Spinal Ultrasound

A56612, Billing and Coding: CT of the Head

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