Does S25.121S require prior authorization?

No, S25.121S does not require prior authorization (high confidence). Covered without prior authorization.

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`S25.121S`, Major laceration of right innominate or subclavian artery, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

When billing these procedures after carotid endarterectomy, include the surgery date and the phrase 'carotid endarterectomy' in the claim narrative.
When reporting a reduced (unilateral/limited) service, append modifier -52 and include an explanation of the reduced service in Item 19 of the CMS-1500 form or electronic equivalent; any appropriate supporting documentation may be submitted with the claim.
Follow Novitas LCD L35397 for the reasonable and necessary documentation requirements and frequency limitations, and consult NCCI edits for correct coding combinations prior to billing Medicare.

Key Coverage Criteria

Non-invasive cerebrovascular arterial studies are covered when reasonable and necessary as defined by Novitas Local Coverage Determination (LCD) L35397.
Duplex post-interventional follow-up studies (typically limited and unilateral) are covered for evaluation after cerebrovascular intervention.
Vascular studies performed after carotid endarterectomy are covered when the claim includes the procedure date and the narrative 'carotid endarterectomy.'
Coverage for thoracic aortography and carotid, vertebral, and subclavian angiography is determined by Local Coverage Determination L35035; services are covered when reasonable and necessary per that LCD.
Non-invasive vascular studies (duplex scan, physiologic studies, plethysmography, transcranial Doppler) are covered when ordered by the treating or consulting practitioner and medically necessary to evaluate, diagnose, or manage vascular disease.
Initial autogenous access vessel mapping should be billed with HCPCS codes 93985 or 93986 and is covered when medically necessary for surgical planning.

20 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

A56758, Billing and Coding: Non-Invasive Vascular Studies

NGS-J6-L33627, Non-Invasive Vascular Studies

FIRST_COAST-L40289, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

FIRST_COAST-L33693, Peripheral Venous Ultrasound

FIRST_COAST-L36767, Aortography and peripheral angiography

FIRST_COAST-L40288, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

A57056, Billing and Coding: Aortography and Peripheral Angiography

NOVITAS-JH-L35397, Non-Invasive Cerebrovascular Arterial Studies

NOVITAS-JH-L40275, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

NOVITAS-JH-L35451, Peripheral Venous Ultrasound

NOVITAS-JH-L40276, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

NOVITAS-JH-L35035, Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

NGS-JK-L33627, Non-Invasive Vascular Studies

A52992, Billing and Coding: Non-Invasive Cerebrovascular Arterial Studies

NOVITAS-JL-L40275, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

A56631, Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

NOVITAS-JL-L35451, Peripheral Venous Ultrasound

NOVITAS-JL-L35397, Non-Invasive Cerebrovascular Arterial Studies

`S25.121S`, Major laceration of right innominate or subclavian artery, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

S25.121S, Major laceration of right innominate or subclavian artery, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`S25.121S`, Major laceration of right innominate or subclavian artery, sequela