Does S32.051B require prior authorization?

No, S32.051B does not require prior authorization (high confidence). Covered without prior authorization.

`S32.051B`, Stable burst fracture of fifth lumbar vertebra, initial encounter for open fracture

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing and coding guidelines that complement Local Coverage Determination (LCD) L37848 for Lumbar Spinal Fusion; refer to LCD L37848 for clinical medical necessity criteria.
Billing and coding for immunizations must follow the coverage indications, limitations, and medical necessity criteria set forth in the associated Local Coverage Determination LCD L34596 (Immunizations).
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.

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.
Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.

CGS-J15-L36460, Bone Mass Measurement

J15

CGS-J18-L36460, Bone Mass Measurement

J18

A56900, Billing and Coding: Immunizations

WPS-J5-L34596, Immunizations

WPS-J8-L34596, Immunizations

A58873, Billing and Coding: Tetanus Immunization

NOVITAS-JH-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A58872, Billing and Coding: Tetanus Immunization

A57206, Billing and Coding: Lumbar MRI

A57311, Billing and Coding: Physical Therapy - Home Health

A59040, Billing and Coding: Bone Mass Measurement

A56396, Billing and Coding: Lumbar Spinal Fusion

A57132, Billing and Coding: Bone Mass Measurement