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ICD-10-CM S02.40AB, Malar fracture, right side, initial encounter for open fracture | No Prior Auth

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`S02.40AB`, Malar fracture, right side, initial encounter for open fracture

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Influenza vaccine claims must contain HCPCS G0008 and diagnosis ICD-10 Z23.
Pneumococcal vaccine claims must contain HCPCS G0009 and diagnosis ICD-10 Z23.
When pneumococcal and influenza vaccines are given the same visit, claims should contain HCPCS G0008 AND G0009 and ICD-10 Z23.

Hepatitis B vaccine claims must contain HCPCS G0010 and diagnosis ICD-10 Z23 and documentation of patient risk status (e.g., ESRD, hemophilia, household contact, sexual/drug-use risk, healthcare worker, institutional resident/staff).

Rabies vaccine claims should be coded with exposure diagnosis Z20.3 to document direct exposure treatment.

Tetanus vaccine claims must be coded with the diagnosis appropriate to the injury; include supporting ICD-10-CM codes that demonstrate medical necessity.

Key Coverage Criteria

COVID-19 vaccines are covered under Medicare Part B (see CMS guidance for vaccine pricing and coding).
Seasonal influenza vaccine is covered once per flu season (use codes 90635, 90637, 90638, 90653-90657, 90660-90662, 90672-90674, 90682, 90685-90689, 90694, 90695, 90756, Q2034-Q2039).
Pneumococcal vaccine is covered as an initial dose for Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B (use codes 90670, 90671, 90677, 90732).
A different, second pneumococcal vaccine is covered when administered at least 1 year after the first pneumococcal vaccine.
Pneumococcal and seasonal influenza vaccines administered during the same visit are both covered (bill seasonal influenza and pneumococcal vaccine codes).
Hepatitis B vaccine is covered only for persons at intermediate-to-high risk (use codes 90739-90740, 90743-90744, 90746-90747, 90759).

9 Active Policies

A56900, Billing and Coding: Immunizations

J5

WPS-J5-L34596, Immunizations

J5

WPS-J8-L34596, Immunizations

J8

A58873, Billing and Coding: Tetanus Immunization

J9

A58872, Billing and Coding: Tetanus Immunization

JL

A56729, Billing and Coding: Magnetic Resonance Imaging of the Head and Neck

A56612, Billing and Coding: CT of the Head

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

A54767, Billing and Coding: Medicare Preventive Coverage for Certain Vaccines

Related Codes

S02.40CB(9 policies)S02.40FB(9 policies)S02.32XB(9 policies)S02.40BB(9 policies)S02.40DB(9 policies)S02.40EB(9 policies)S02.31XB(9 policies)S02.611B(9 policies)

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