Does S03.42XS require prior authorization?

No, S03.42XS does not require prior authorization (high confidence). Covered without prior authorization.

`S03.42XS`, Sprain of jaw, left side, sequela

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Billing and coding guidance in this policy complements and references Local Coverage Determination L34425; claims should be supported per the documentation requirements specified in LCD L34425.
The clinical record must document the elements leading to the diagnosis and the treatment decision to use injection (history, exam findings, diagnostic rationale).
Records must be made available upon request to support coding and medical necessity determinations.

No specific clinical indications are listed in this billing/coding guidance; coverage determinations for MRI of the head and neck follow Local Coverage Determination L34425.
Injection therapy for Morton's neuroma (focal injection of tissue surrounding a localized plantar digital inflammatory focus) should be billed using CPT 64455 or 64632.
Injection therapy for plantar fasciitis is addressed and billed with CPT 20550 and corresponds to ICD-10-CM M72.2.
Injection to tendons at their origin or insertion sites should be reported using CPT 20551.
A single CPT 20551 should be reported when injections include both the plantar fascia and the area around a calcaneal spur.

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

A57079, Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma

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