Does S06.5X8A require prior authorization?

No, S06.5X8A does not require prior authorization (high confidence). Covered without prior authorization.

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`S06.5X8A`, Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to other cause before regaining 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

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

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

A56937, Billing and Coding: Psychiatry and Psychology Services

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

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

NGS-J6-L33632, Psychiatry and Psychology Services

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-L34975, Neurophysiology Evoked Potentials (NEPs)

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

NGS-JK-L33632, Psychiatry and Psychology Services

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

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

A56773, Billing and Coding: Neurophysiology Evoked Potentials (NEPs)

A57040, Billing and Coding: Speech-Language Pathology

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

`S06.5X8A`, Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to other cause before regaining consciousness, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

S06.5X8A, Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to other cause before regaining consciousness, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`S06.5X8A`, Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to other cause before regaining consciousness, initial encounter