Does S22.052A require prior authorization?

No, S22.052A does not require prior authorization (high confidence). Covered without prior authorization.

`S22.052A`, Unstable burst fracture of T5-T6 vertebra, initial encounter for closed fracture

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
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).

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.
Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
Beneficiary is under the care of a physician.

CGS-J15-L36460, Bone Mass Measurement

J15

CGS-J18-L36460, Bone Mass Measurement

J18

WPS-J5-L34623, Intraoperative Neurophysiological Testing

A57604, Billing and Coding: Intraoperative Neurophysiological Testing

WPS-J5-L38213, Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

A57630, Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

WPS-J8-L38213, Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

WPS-J8-L34623, Intraoperative Neurophysiological Testing

NOVITAS-JH-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A57132, Billing and Coding: Bone Mass Measurement

A57311, Billing and Coding: Physical Therapy - Home Health

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

A59040, Billing and Coding: Bone Mass Measurement