Does S06.5X0A require prior authorization?

No, S06.5X0A does not require prior authorization (high confidence). Covered without prior authorization.

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`S06.5X0A`, Traumatic subdural hemorrhage 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.
MRA is covered to evaluate blood flow in the internal carotid vessels of the head and neck.
MRA of peripheral arteries of the lower extremities is covered to determine the presence and extent of peripheral vascular disease and may substitute for conventional angiography (CA).
MRA is covered for pre-operative evaluation of patients undergoing elective abdominal aortic aneurysm (AAA) repair when it is comparable to CA for determining extent of AAA and evaluating aortoiliac occlusive disease and renal artery pathology necessary for surgical planning.
MRA of the renal arteries and aortoiliac arteries (in the absence of AAA or aortic dissection) is covered when MRA is expected to avoid CA, physician history/physical and standard assessments are insufficient, and obtaining MRA has a high probability of positively affecting patient management.
MRA of the chest is covered for diagnosis of suspected pulmonary embolism when the patient has a contraindication to receiving intravascular iodinated contrast material.

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

A56747, Billing and Coding: Magnetic Resonance Angiography (MRA)

A56937, Billing and Coding: Psychiatry and Psychology Services

NGS-J6-L33632, Psychiatry and Psychology Services

NGS-J6-L33633, Magnetic Resonance Angiography (MRA)

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

A56537, Billing and Coding: 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-L34865, Magnetic Resonance Angiography (MRA)

NOVITAS-JH-L34975, Neurophysiology Evoked Potentials (NEPs)

NOVITAS-JH-L35101, Psychiatric Codes

NGS-JK-L33632, Psychiatry and Psychology Services

`S06.5X0A`, Traumatic subdural hemorrhage without loss of consciousness, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

S06.5X0A, Traumatic subdural hemorrhage without loss of consciousness, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`S06.5X0A`, Traumatic subdural hemorrhage without loss of consciousness, initial encounter