Does S05.10XS require prior authorization?

No, S05.10XS does not require prior authorization (high confidence). Covered without prior authorization.

`S05.10XS`, Contusion of eyeball and orbital tissues, unspecified eye, sequela

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
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.
Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Posterior segment OCT is reasonable and necessary to diagnose and manage retinal and neuro-ophthalmic diseases involving the optic nerve, subretinal and intraretinal abnormalities, vitreoretinal relationships, or retinal nerve fiber layer changes.
Posterior segment OCT is reasonable and necessary to diagnose early glaucoma and to monitor glaucoma treatment.

NGS-J6-L34380, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

A56537, Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

FIRST_COAST-L33766, Visual Field Examination

A57637, Billing and Coding: Visual Field Examination

NGS-JK-L34380, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

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.