Does S06.1X0A require prior authorization?

No, S06.1X0A does not require prior authorization (high confidence). Covered without prior authorization.

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`S06.1X0A`, Traumatic cerebral edema without loss of consciousness, initial 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.

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.
Psychiatric/psychological services are covered when there is a reasonable expectation that withdrawing treatment would cause the patient's condition to deteriorate, relapse, or require hospitalization.
CORF social and psychological services are covered when indicated and may be provided by qualified social workers (minimum BS) or psychologists (minimum Master’s level).
Psychiatric diagnostic procedures may be billed once per day and are covered at the outset of an illness or suspected illness, or again for a new episode after a hiatus or on (re)admission for complications of the underlying condition.
Psychotherapy codes that include an E/M component are payable when performed by physicians, physician assistants (PA), nurse practitioners (NP), or clinical nurse specialists (CNS) and the E/M component is documented in the record.
Interactive complexity add-on code 90785 may be reported in conjunction with specified diagnostic and psychotherapy codes when interactive complexity is present.

20 Active Policies

CGS-J15-L34046, Speech-Language Pathology

J15

CGS-J18-L34046, Speech-Language Pathology

J18

WPS-J5-L34615, Visual Fields

A57483, Billing and Coding: Visual Fields

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

A56937, Billing and Coding: Psychiatry and Psychology Services

NGS-J6-L33632, Psychiatry and Psychology Services

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

WPS-J8-L34615, Visual Fields

A57780, Billing and Coding: Psychological and Neuropsychological Tests

FIRST_COAST-L34520, Psychological and Neuropsychological Tests

FIRST_COAST-L36767, Aortography and peripheral angiography

A57056, Billing and Coding: Aortography and Peripheral Angiography

NOVITAS-JH-L35035, Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

NOVITAS-JH-L35070, Speech - Language Pathology (SLP) Services: Communication Disorders

NOVITAS-JH-L35101, Psychiatric Codes

NOVITAS-JH-L35434, Oximetry Services

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

NGS-JK-L33632, Psychiatry and Psychology Services

A57205, Billing and Coding: Oximetry Services

`S06.1X0A`, Traumatic cerebral edema without loss of consciousness, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

S06.1X0A, Traumatic cerebral edema without loss of consciousness, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`S06.1X0A`, Traumatic cerebral edema without loss of consciousness, initial encounter