Does S05.92XD require prior authorization?

No, S05.92XD does not require prior authorization (high confidence). Covered without prior authorization.

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`S05.92XD`, Unspecified injury of left eye and orbit, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.

This policy provides billing, coding, and guideline information that complements the Local Coverage Determination (LCD) 'Cosmetic and Reconstructive Surgery' L33428; the full policy content is not included here, so specific documentation requirements (e.g., medical records, prior authorizations, forms) are not available in the provided excerpt.

Key Coverage Criteria

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.
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.
Posterior segment OCT may be used to differentiate causes of optic nerve disorders when the diagnosis is uncertain.

5 Active Policies

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

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

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

A56658, Billing and Coding: Cosmetic and Reconstructive Surgery

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

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S05.92XD, Unspecified injury of left eye and orbit, subsequent encounter