Does S22.000B require prior authorization?

No, S22.000B does not require prior authorization (high confidence). Covered without prior authorization.

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`S22.000B`, Wedge compression fracture of unspecified thoracic vertebra, initial encounter for open fracture

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

All services ordered or rendered to Medicare beneficiaries must be signed; providers/suppliers must notify beneficiaries in writing prior to rendering the service if aware the test/item/procedure may not be covered.
A valid ICD-10-CM diagnosis code that best describes the patient's condition must be reported on the claim; claims without a valid ICD-10-CM code will be returned as incomplete under Section 1833(e).
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

The patient's medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.

When services are likely to be non-covered, use an Advance Beneficiary Notice (ABN) and the appropriate modifier (-GA, -GX, -GY, or -GZ) as applicable; for Part A claims with GA, include occurrence code 32 and the date of the ABN and have Form CMS-R-131 signed by the beneficiary.

Key Coverage Criteria

Bone mass measurement tests are covered when ordered by the treating physician or a qualified non-physician practitioner authorized by state law.
An initial bone mass measurement is covered (Medicare reimbursement for an initial bone mass measurement may be allowed only once, regardless of sites studied).
A DXA confirmatory test may be performed and covered as a baseline for future monitoring (exception to the 'one type only' rule).
CPT code 77082 (vertebral fracture assessment) is covered when medically necessary, with symptoms documented and when results are anticipated to be used in patient management.
Bone mass measurement services are covered when they meet the clinical indications and medical necessity criteria specified in the related Local Coverage Determination L39268.
Tenivac (Td) indicated for prevention of tetanus and diphtheria in persons 7 years of age and older (booster every 10 years or as part of 3-shot series if unvaccinated).

8 Active Policies

CGS-J15-L36460, Bone Mass Measurement

J15

CGS-J18-L36460, Bone Mass Measurement

J18

NOVITAS-JH-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A59040, Billing and Coding: Bone Mass Measurement

AETNA-CPB-0653, Diphtheria, Tetanus, and Pertussis Vaccines

A57132, Billing and Coding: Bone Mass Measurement

`S22.000B`, Wedge compression fracture of unspecified thoracic vertebra, initial encounter for open fracture

Prior Authorization

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

S22.000B, Wedge compression fracture of unspecified thoracic vertebra, initial encounter for open fracture

Prior Authorization

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

`S22.000B`, Wedge compression fracture of unspecified thoracic vertebra, initial encounter for open fracture