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ICD-10-CM S21.95XS, Open bite of unspecified part of thorax, sequela | No Prior Auth

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`S21.95XS`, Open bite of unspecified part of thorax, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

Cyanide poisoning;or
Decompression sickness;or
Systemic hyperbaric oxygen pressurization is consideredmedically necessaryin the treatment of any of the following conditions when performed in accordance with Undersea and Hyperbaric Medical Society (UHMS) guidelines:
Acute peripheral arterial insufficiency;or
Acute thermal burns: deep second degree or third degree in nature;or
Acute traumatic ischemia;or

1 Active Policy

ANTHEM-CG-MED-73, Hyperbaric Oxygen Therapy (Systemic/Topical)

Related Codes

A42.0(1 policies)A42.9(1 policies)A4575(1 policies)A48.0(1 policies)B36.0(1 policies)B36.9(1 policies)B37.0(1 policies)99183(1 policies)

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