Does S30.867S require prior authorization?

No, S30.867S does not require prior authorization (high confidence). Covered without prior authorization.

`S30.867S`, Insect bite (nonvenomous) of anus, 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.
Acanthamoeba in corneal ulceration
Actinomyces, for identification of actinomyces species in tissue specimens
Adenovirus, to diagnose adenovirus myocarditis, and to diagnose adenovirus infection in immunocompromised hosts, including transplant recipients
Anaplastic lymphoma kinase (ALK) testing as an alternative to FISH for selecting individuals for ALK inhibitor therapy

CGS-J15-L34032, Debridement Services

J15

CGS-J18-L34032, Debridement Services

J18

AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications

A56459, Billing and Coding: Debridement Services

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