Does S30.853S require prior authorization?

No, S30.853S does not require prior authorization (high confidence). Covered without prior authorization.

`S30.853S`, Superficial foreign body of scrotum and testes, sequela

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The patient’s medical record must include the ordering provider’s assessment as it relates to the patient’s complaint for that visit.
Medical records must contain relevant medical history and results of pertinent tests or procedures performed.
For diagnostic tests, report the result of the test if known; otherwise report the symptoms that prompted performing the test.
All services ordered or rendered to Medicare beneficiaries must be signed and dated; include a signed and dated office visit record or operative report in the medical record.

A valid ICD-10-CM diagnosis code that best describes the patient’s condition for which the debridement service was performed must be reported on the claim.
When a service requires a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
The use of scrotal ultrasound is consideredmedically necessaryfor the following conditions:
Evaluation of acute scrotal symptoms (for example, pain, swelling) and trauma;or
Evaluation of scrotal asymmetry or enlargement (including suspected hydroceles);or
Evaluation of scrotal masses;or

CGS-J15-L34032, Debridement Services

J15

CGS-J18-L34032, Debridement Services

J18

ANTHEM-CG-RAD-27, Scrotal Ultrasound

A56459, Billing and Coding: Debridement Services

Ask Backwork about documentation requirements, denial risks, or coverage in your state.