Does S15.099A require prior authorization?

No, S15.099A does not require prior authorization (high confidence). Covered without prior authorization.

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`S15.099A`, Other specified injury of unspecified carotid artery, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

A hard copy or a soft copy convertible to a hard copy providing a permanent record of the study is required and must meet accepted radiologic/ultrasonographic quality standards.
If the performing provider is different from the ordering/referring clinician, the performing provider must maintain a copy of test results and interpretation, and the ordering/referring clinician must document the clinical indication/medical necessity in the order.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request, with every page legible and including complete patient identification and dates of service.

The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.

Submitted medical records must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must describe the service performed.

An order from the treating physician or non-physician practitioner is required as specified in CFR Title 42 § 410.32(a) for ordering diagnostic tests.

Key Coverage Criteria

Non-invasive extracranial arterial studies are covered only when the service meets all clinical indications and limitations specified in LCD L33695 and all applicable CMS national coverage determinations and Medicare medical necessity requirements.
Evaluation is covered for patients with vasculitis involving the extracranial carotid arteries.
Evaluation is covered for patients with proven carotid disease on medical management whose cerebrovascular symptoms become recurrent.
Evaluation is covered for patients presenting with carotid artery injury or blunt neck trauma.
Initial non-invasive extracranial arterial study is covered for an asymptomatic carotid bruit identified on physical examination.
Non-invasive extracranial arterial study is covered to evaluate a symptomatic patient with a carotid bruit.

2 Active Policies

FIRST_COAST-L33695, Non-invasive Extracranial Arterial Studies

A57670, Billing and Coding: Non-invasive Extracranial Arterial Studies

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S15.099A, Other specified injury of unspecified carotid artery, initial encounter