Does S32.119B require prior authorization?

No, S32.119B does not require prior authorization (high confidence). Covered without prior authorization.

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`S32.119B`, Unspecified Zone I fracture of sacrum, initial encounter for open fracture

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
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).

The patient's medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.

Key Coverage Criteria

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.
Bone mass measurement services are covered when they meet the clinical indications and medical necessity criteria specified in the related Local Coverage Determination L39268.
Bone mass measurement is covered when performed with a covered testing modality (dual-energy x-ray absorptiometry (DXA), radiographic absorptiometry (RA), bone sonometry (ultrasound), single energy x-ray absorptiometry (SEXA), or quantitative computed tomography (QCT)).

8 Active Policies

CGS-J15-L36460, Bone Mass Measurement

J15

CGS-J18-L36460, Bone Mass Measurement

J18

NOVITAS-JH-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A59040, Billing and Coding: Bone Mass Measurement

A56421, Billing and Coding: CT of the Abdomen and Pelvis

A57132, Billing and Coding: Bone Mass Measurement

`S32.119B`, Unspecified Zone I fracture of sacrum, initial encounter for open fracture

Prior Authorization

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

S32.119B, Unspecified Zone I fracture of sacrum, initial encounter for open fracture

Prior Authorization

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

`S32.119B`, Unspecified Zone I fracture of sacrum, initial encounter for open fracture